Fitness for Menopause Myths Busted: What Actually Works for Muscle, Metabolism, and Hormone Balance | Stephanie Estima

Dr. Estima: [00:00:00] Muscle and bone are sisters, like what happens to one happens to the other. So as our lean muscle, our muscle mass goes up. Same happens with our bone density. It will also go up and there's different types of bone density, but just generally the more muscle you have, the better your bone density is gonna be.

Having more muscle tissue really provides a very strong metabolic benefit. The myocyte, the muscle as a whole is the primary site for glucose utilization, glucose storage, we call that glycogen or fat utilization. Fat regulation. 

Dr. Brighten: When people are looking at protein intake, how much protein should be, should women be consuming at this phase of life?

Narrator: Dr. Stephanie Tima 

Dr. Brighten: is a chiropractic doctor focused on female health, longevity, and performance. 

Narrator: As host of Better with Dr. Stephanie Tima, a top rated podcast with over 5 million downloads. 

Dr. Estima: She makes cutting edge science accessible and actionable, 

Narrator: a sought after speaker and writer. She empowers women with practical tools to optimize their health [00:01:00] 

Dr. Estima: in the context of women carbohydrates.

Again, not the devil. What they do is they provide or they prevent muscle protein breakdown. So the sort of equation for whether your muscles are gonna grow is like 

Dr. Brighten: when we talk about perimenopause and fitness, what is the best form of exercise women should be doing? 

Dr. Estima: Oh, this is sort of a trick question, uh, but 

Dr. Brighten: I will say.

Welcome back to the Dr. Brighten Show. I'm your host, Dr. Jolene Brighten. I'm board certified in Naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most UpToDate information to help you take charge of your health and take back your hormones.

If you enjoy this kind of information, I invite you to visit my website, dr Brighten.com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including updates on this podcast. Now, as always, [00:02:00] this information is brought to you cost free, and because of that, I have to say thank you to my.

For making this possible. It's my aim to make sure that you can have all the tools and resources in your hands and that we end the gatekeeping. And in order to do that, I do have to get support for this podcast. Thank you so much for being here. I know your time is so valuable and so important, and it's not lost on me that you're sharing it with me right now.

Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. Dr. Stephanie Isma, welcome to the show. 

Dr. Estima: I am just delighted to be here. 

Dr. Brighten: Thank 

Dr. Estima: you for inviting me. 

Dr. Brighten: Yeah, we're gonna have an awesome conversation talking about exercise perimenopause, all the ins and outs, but the first thing I have to ask you is I, it's your birthday.

Happy birthday. Thank you very much. I saw your list and you were like a cute gym outfit Does affect your performance. Yes. Say [00:03:00] more. 

Dr. Estima: It's directly proportional to the energy that you have in the gym and your desire to go to muscle failure. Mm-hmm. That's at least my end of one. My end of one is that the cuter my gym outfit is, the better, the better gains.

Like the more, the more I have fun in the gym. 

Dr. Brighten: Yeah. I have to say, like, one of the like motivators for me to get up is, and work out is like immediately I have to put on a gym outfit. That feels good. Yeah, that looks good. That I like, and nothing itchy, scratchy. But if I do that first thing, then it's like, there's no excuses.

You're dressed for it. Make it happen. Totally. 

Dr. Estima: Yeah. A hundred percent. And I think that changes for me over the course of the month, like what fits me and how I, you know, how much skin I wanna show, all of that kind of stuff. But I think that the, the health in general is really a feeling. It's not a look, but if you feel like you, you look cute, then I think that there's a, there's sort of a knock on effect that just makes you feel more confident.

You show up differently, you walk a little differently. Yeah. And then there's a bit more of a, maybe at least I find a little bit more of a drive to work harder because you're like, well, I'm here, I'm in, I [00:04:00] have my business all done, so let's do this. Yeah. 

Dr. Brighten: Yeah. No, I, I like that. And I think it is something that, uh.

People get kind of like, they'll, they'll drag people on the internet being like, why are these women wearing these outfits? And it's, it can be a motivator, especially when you are working. I think sometimes some people need that like carrot where they're like, I am, if I work out like x number of days, I get a new gym outfit.

Yeah. And that is something that if that motivates you, like you should just own that. Like, we have to find the hacks. 

Dr. Estima: I think that there, I love what you just said there. 'cause I, I have seen that as like, why are the girls showing all the things? And it's like, well if she feels good in it, it's none of your business.

Yeah. Like she's not asking for your commentary. She's going to the gym in a way that makes her feel good. And like I said, there's no one size, there's no one. Look, uh, health, like I like to talk is a feeling. It's how we feel. Mm-hmm. And if you feel good in the outfit that you're wearing and that makes you feel sexy, hot.

Strong, whatever. [00:05:00] Then you do, you boo. Then it's nobody el nobody else should be making comments on that. Good, bad, ugly. 

Dr. Brighten: Yeah. 

Dr. Estima: Yeah. 

Dr. Brighten: Well, it's also something too that I think men fail to recognize that we wear our outfits for us and not for them. Yes, yes. And my husband, bless him, uh, he'll be like, oh, I like that.

Like wear that outfit. I like it. And I'm like, I'm not wearing it for you. This is for me. Yes. I like it. I'm wearing it. Right, right. And I'm like, and if you also enjoy it, like awesome. Yes. But I have to wear stuff for me to feel good and what I feel confident in. 

Dr. Estima: A hundred percent. And even, you know, when, now when you go to the gym, it's very common to see people taking selfies or pictures of themselves and it's like.

You have worked hard for that. Yeah. You know, which protein that those people have ma like consumed to have those shoulders and those biceps like take the damn selfie. So again, I think that it's, um, yeah, I, I am really a big believer in like, you do you, if it makes you feel good and that's gonna be the carrot, like you said mm-hmm.

That's gonna get you to the gym or to, you know, take the class or to join a community, join a [00:06:00] run club, whatever it is, then that's fine. 

Dr. Brighten: Yeah. 

Dr. Estima: That's totally fine. 

Dr. Brighten: Well, let me ask you, when we talk about perimenopause and fitness, what is the best form of exercise women should be doing? 

Dr. Estima: Oh, this is sort of a trick question.

Uh, but I will say, I think that all forms of fitness. Oh, let me say it this way. The, the type of movement patterns and exercises that you like are the best choice for you. There's going to be some variability there. Mm-hmm. I will say that the one non-negotiable is gonna be resistance training. Okay. So I will state my bias, uh, neuro, you know, my whole field of study is neuro musculoskeletal.

Uh, and so I can see the benefits in terms of bone health, long-term joint health. Mm-hmm. Long-term ligaments, tendons, long-term muscle, you know, muscle quality and the maintenance of that lean muscle mass over, you know, long delta when we are resistance training. Yeah. And so I think that every. Movement, every exercise program should have a foundation for resistance training in it.

Mm-hmm. And I think that this is especially [00:07:00] true, you know, to your point around perimenopause, because if we're not being strategic about it in midlife and beyond, we are gonna start losing muscle mass if we're not stimulating the tissue. Mm-hmm. We're gonna start losing bone mass if we're not stimulating the tissue.

And I always like to counsel people to think about muscle and bone. Are sisters like what happens to one happens to the other? Yeah. So as our lean muscle, our muscle mass goes up. Same happens with our bone density. It will also go up and there's different types of bone density, but just generally for everyone to understand, the more muscle you have, the better your bone density is gonna be.

Um, and then the opposite's also true. The less muscle mass you have, your, your bones are gonna become more brittle and more likely to shatter. Yeah. If there's some type of acute trauma, like a fall or you know, trip or something like that. So I would say that, um. A lot of people ask, well, what about Pilates?

Does that count? And yoga does that count? And what about cardio? And it's like, yes. All of those. And we need to make sure that every perimenopausal woman is [00:08:00] doing a, a resistance training program at a minimum of two times a week. And then depending on her fitness level and how many, you know, what her goals might be, then we can sort of gradient that.

We can bring that up. Mm-hmm. We can dial that up. Um, but I think two times a week, uh, and I'll also just say some people are like, Ugh, two times a week. It's like, do you know what great, fantastic results you can get with a woman? Yeah. Who has not trained, who now starts training twice a week. You can get incredible results in terms of body composition.

Mm-hmm. Mood affect, sleep hormones, like all the things that resistance training. Gives you, 

Dr. Brighten: yeah. Yeah. I lift Pilates for the pelvic floor. Do the Pilates to keep your pelvic floor healthy. Poor 

Dr. Estima: posture. Yeah. Um, it's 

Dr. Brighten: fantastic. But to your point about resistance training, I'm imagining there's some people right now who, maybe they're marathon runners or they have a different form of exercise, maybe they're not exercising at all.

When you say resistance training, what are we talking about specifically? 

Dr. Estima: So we're talking about lifting weights and we're talking specifically about lifting weights. Approximating failure. Mm-hmm. So if you're a marathon runner or you're, [00:09:00] what I lovingly call like the Pilates princesses and all of the, that all can stay and should stay because it's part of something that you love to do.

Yeah. And that's really important when we're thinking about movement. But resistance training is basically lifting weights. It's either using machines at the gym, which is where a lot of people will start, or with dumbbells. Mm-hmm. But actually machines are, you know, if you're a beginner, I really love a lot of people PPO machines.

But what's really nice about them, especially if you don't have that neuromuscular, uh, skeletal, or I should say neuromuscular. Connection or that mind muscle connection. Yeah. That motor patterning a a a machine will have a predictive line of drive, like you, you know where the seat's gonna go or you know, where the, you know, where the levers are gonna move.

Mm-hmm. And so that's a beautiful place to start. And then over time, as you become more of an advanced lifter, you can graduate to dumbbells, barbells, kettlebells, et cetera, where there's, where you require more stability in order to, and then maybe accessory muscles and adjunctive muscles in order to perform the movement properly.

Mm-hmm. So it's basically. [00:10:00] As heavy of a weight that you can manage in a range of motion that you can own approximating muscle failure. And I can define all those terms for you too. Yeah, let's 

Dr. Brighten: do it. Break it down for people. 

Dr. Estima: Yeah. So, um, one of the things that I just will pre-frame what I'm about to say is I know that a lot of people listening, you know, probably grew up in the cardio section of the gym.

Mm-hmm. And now we're, now they're probably hearing like, lift heavy stuff. Lift heavy weights, lift heavy weights. Yeah. And so I think that there's a real and valid. Um, concern or even fear around injury, right? Because if you're 40 and all you've ever done is the elliptical and now you're like, oh, I guess I need to squat and lunge and deadlift and pull up and all of these things.

Yeah. Um, if you don't have the motor, if you don't have the motor pattern or that kinetic memory, then you do have a higher incidence or propensity towards injury. Mm-hmm. So I like to talk about heavy weights. It's gonna be very individual, so you and I might, you know, squat different, uh, you know, weights, we might [00:11:00] bicep, curl, or do a different amount of pull-ups.

It actually doesn't matter what the absolute weight is. Mm-hmm. It just means that it's heavy enough for you so that by the end of the set. So let's just pretend that your set is 10 repetitions. So, you know, set or rep one, two, and three, they're gonna be like pretty easy, like you're feeling good doing that, that movement, and then by rep.

Eight, nine, and 10. The weight should be heavy enough so that you're questioning whether or not you can do eight, nine, and 10. Yeah, like it should be difficult enough where the perception of the weight actually goes up, so it actually feels heavier towards the end of the set than it did in the beginning.

Mm-hmm. You'll also notice as you approximate or get close to muscle failure, that the velocity in which you're able to do the rep slows down. Yeah. So you'll get slower and you'll have to actually power through and try to push through that full range of motion. Um, and then the other thing I'll say, actually with range of motion, uh, especially for my [00:12:00] 40-year-old and 50-year-old, uh, you know, uh, muscle mommies we'll just call you, um, is that you might also be dealing with some type of degenerative joint or disc mm-hmm.

Or, you know, some tendonitis or frozen shoulder or something like that. Um, so we just wanna say. Full range of motion is optimal except when it's, and when you can't. Yeah. So in that case, like let's say you're dealing with osteoarthritis or rheumatoid arthritis, which are both, uh, autoimmune conditions that destroy the joints, where now it's not necessarily about lifting as heavy weight as you can.

It's about actually preserving range of motion. So whatever the range of motion is that you have, you should be just aiming to maintain that. And then over again, long delta, long period of time, we can start thinking about slowly and gently increasing that range of motion. Mm-hmm. With like an arthro tide, let's say, or you know, all the women that we know that get diagnosed with frozen shoulder.

Yeah. Where we have this sort of cooling and then freezing and then thawing phase. We wanna be thinking about, we [00:13:00] wanna be thinking about preserving as much as we can. The range of motion that they have. 

Dr. Brighten: Mm-hmm. 

Dr. Estima: Yeah. 

Dr. Brighten: I've seen you talk about how. Four sets is something you should be aiming for in perimenopause.

I think a lot of people will hear things like, oh, if you can do like two sets or you can do three sets. But yeah, you've specifically, I've seen you on social media say like four is what you're aiming for. So let's talk about why I like four sets. Why, why the four sets 

Dr. Estima: I think for, and so I would classify myself as sort of like an intermediate to advanced lifter.

I've been doing it for many decades. Um, and I feel like. First, I'll say that we wanna also distinguish between a working set 

Dr. Brighten: mm-hmm. And a 

Dr. Estima: warmup set. Yeah. So the, the four is usually, you know, a lot of women have this sort of like pre, like, I'm gonna do three sets, it's gonna be 12 to 15 reps, and there's nothing wrong with that.

We can build lots of gorgeous muscle in that. Mm-hmm. But so often when we start lifting, you're still warming up, like you're still priming the nervous system. Yeah. So I actually just like to tack on an extra set. Mm-hmm. Uh, at the, [00:14:00] you know, for whatever exercises, let's say we're talking about. Squats, um, you know, set one and two can be warmup sets where you're actually priming the nervous system.

You're getting some of that cortisol and that noradrenaline run going. Mm-hmm. Which is actually, you know, exercise is a stress, uh, a hormetic one, but it is a stress nonetheless. So we want to, uh, if you, if you just have three sets of squats, let's say in your repertoire and you've done two warmup sets, that means you only have one real working set and then you're off to the next thing.

So there's not quite as much stimulus there as I would like. So I would say we wanna also just to kind of give a little bit more nuance to why four we want to break down or even just. Differentiate between a, a warmup set where you're just kind of like getting going, the joints are getting lubricated, the muscles are getting, you know, they're starting to work.

And then a working set, which is where we're ap, approaching that muscle failure that we were talking about. 

Dr. Brighten: Mm-hmm. 

Dr. Estima: Yeah, and 

Dr. Brighten: you see this in the research as well where there's researchers who are [00:15:00] even saying like, trying to go heavier and doing less reps, but going for that extra set. Yeah. Can really.

Stimulate the muscles. And that, let, let me have you explain why it's so important that we be stimulating these muscles in such a way. 'cause we are working against something very serious Yeah. As we enter our forties. 

Dr. Estima: Yeah. Um, I would say that when we're thinking about hypertrophy, which is what we're, what this conversation is, muscle hypertrophy is just like fancy for making new muscle.

Dr. Brighten: Yeah. 

Dr. Estima: Um, volume is really like queen here. So we wanna be thinking about the more volume that we can accumulate over the course of the week, the more stimulus that we can impart into that, into that muscle tissue, the better chance we're gonna have to grow new tissue and at the amount that we want.

Mm-hmm. So volume is really, you know, king or queen, uh, here. So that's why we want that. We want those extra sets. And then just from a maybe mechanistic point of view, like why muscle is even a topic of. [00:16:00] Of consideration in perimenopause. Yeah. One, uh, is a mobility function, so we've kind of touched on it a little bit with some of the arthrosis where we see that destruction of the joint.

But a 40-year-old, even like a 50-year-old, uh, early sixties, we don't really think about mobility too much. Mm-hmm. 

Dr. Brighten: But 

Dr. Estima: once you kind of get 65, 75, 85, you know, if you fall 

Dr. Brighten: Yeah. 

Dr. Estima: And you fracture, something like that could be catastrophic for you. Mm-hmm. Right. So we wanna be thinking like we wanna preserve muscle tissue and the joints for that mobility benefit that it provides us and that ambulatory benefit that it provides us.

Um, I was actually just speaking, uh, today about this and there's some sobering stats if I can share. Um, last year the CDC reported there was 300,000, uh, falls that were hip fractures. Mm-hmm. That required hospitalization. 75% of those. Patients were female. Um, within the first year of that hip fracture, we had [00:17:00] 50% of the, um, the patients didn't make it.

Yeah. Meaning that they died. So we have a, um, a very high mortality rate that follows something like a hip fracture. Mm-hmm. And then at the end of that one year, we still had 50% of those patients hospitalized. Yeah. Right. So this can be absolutely devastating to a woman's life and her, you know, and her living the, you know, the golden years or the last decade or two for her.

Dr. Brighten: Yeah. Um, 

Dr. Estima: so that's one thing. The other thing I'll say too, and this is relevant right now, you know, if you're 35, 45, 55, what have you, is that having more muscle tissue really provides a very strong metabolic benefit. Mm-hmm. 

Dr. Brighten: Right. 

Dr. Estima: So the muscle, the myocyte, the muscle as a whole is the primary site for glucose utilization.

Dr. Brighten: Yeah. 

Dr. Estima: Uh, glucose storage, we call that glycogen, as you know. Fat utilization. Uh, one of the things that I often see, I'm sure you've seen this like a hundred thousand times at this point, is a woman in perimenopause is like, I'm literally doing the same thing that I've always done. 

Dr. Brighten: I've done [00:18:00] everything I'm, and I'm gaining weight and gaining weight.

My body's changing, gaining weight 

Dr. Estima: a hundred percent. And I have now all this like, you know, fat distribution through my abdomen, I'm gaining belly fat. And when we look at her lipid panels mm-hmm. We see this DYS reg or this sort of, you know, her tr her triglycerides are through the roof. Her total cholesterol is going up.

Yep. Her l DLC is going up. And this is because muscle is the primary site for fat utilization and fat regulation. 

Dr. Brighten: Mm-hmm. 

Dr. Estima: Um, so thinking about our muscle is gonna help with, you know. Our consumption of carbohydrates and the reaction that our body has to that. Yeah, you can have more carbs, you're more insulin sensitive.

Um, your lipids are gonna stay under control. Uh, from a hormonal perspective, every time we lift weights, we are producing our own in order to maintain that new muscle that's being created. Mm-hmm. As you know, I mean, I'm speaking to the choir here, but you know, as you know, but, 

Dr. Brighten: but the people who are listening don't know.

Yes. For the people who are listening, break it down. Yeah. Like 

Dr. Estima: we have this endogenous meaning like our own body creates testosterone. Mm-hmm. The more muscle you have, the more natural testosterone that you need in order [00:19:00] to maintain that muscle. And then there's some really interesting literature around balancing the, uh, PDE or the progesterone to estradiol ratio mm-hmm.

In the second half of the cycle. Uh, meaning that if you are someone who typically runs estrogen dominant, which is, I know that people like get a bit of a. A twitch when I say that, but we'll just say like estrogen dominant in the luteal phase of the cycle. Well, what's funny 

Dr. Brighten: is that the research is like, oh, you're in a hyper estrogen state.

And they're like, okay, well that's okay. And it's very much like HPA dysregulation. If the lay person calls it adrenal fatigue, that's fine for the lay person to call it that. Sure. And we can educate that estrogen dominance is hypoestrogenism. Yes. This is well supported in the research. Yes. But I think that like people, like people play with words.

Dr. Estima: It's a Samantha game. Well, they get 

Dr. Brighten: like so upset because I, and I think this is a big part of it because jargon is a way to gate keep information from people. Yes. Yes. And to keep their ego elevated as they keep all the information so you have to come to them. Yeah. And I just am like, [00:20:00] like if somebody is coming and they don't feel good to you to feel better, just.

Shut up with your jargon. Yeah. Like help 'em out. 

Dr. Estima: We don't need to speak medicalese. You know, I think that I do really like what you just said there, and I think it's an important point to, to sort of underline and highlight is that gatekeeping aspect. 

Dr. Brighten: Yeah. The 

Dr. Estima: information should be available to everybody, every woman.

It's like no longer a luxury that you could just delegate your health to someone else. We do have to be active participants in our own prognosis and our own outcomes. Mm-hmm. And so I think that when we can talk in language that's not, um. I don't know, supe, like have, that has this sort of superior superiority complex.

Yeah. Um, and it's just like plain, everyday language that you and I would use in a regular conversation. And it's accessibility. Yes. Like, yes, 

Dr. Brighten: you should make information accessible to people, right? 

Dr. Estima: Yeah. Yeah. So. My, my original point was that it helps upregulate progesterone production, which we know progesterone kind of downregulates estrogen receptor cell, you know, receptors mm-hmm.

[00:21:00] And down like kind of feedbacks up to the brain to sort of downregulate estrogen production. Estrogen production at large. Um, so there's this nice balance if you are still cycling and you have a luteal, like you've ovulate, so now you have, you know, progesterone being, um, secreted that we have this nice PDE balance.

Mm-hmm. So there's like a, I mean, and then there's like the mykines and the mood and the sleep and all the things that Muscle does. 

Dr. Brighten: Yeah. Uh, 

Dr. Estima: for the body. But those would be like the big three. It's like mobility, metabolic, menstrual. 

Dr. Brighten: Mm-hmm. Yeah. I love that. And I think also for people to understand, because sometimes people will say, well, I have hypothyroidism, so I can't exercise.

And I'm like, as someone who's had hypothyroidism, I know how hard that is. And at the same time, we have to find some kind of movement. So when progesterones optimize, we actually utilize a thyroid hormone better. But also our activation of thyroid hormone comes through movement. And so I just want everybody who's listening to this, if you're like, but because of this, it's hard to move.

We have to find some way to move. My question to [00:22:00] you is that there's certainly people who have disabilities, they can't go and squat. Maybe they are wheelchair bound, maybe there are accommodations that need to be made. 

Dr. Estima: Yeah. 

Dr. Brighten: What are some ways that they can start to access strength training? 

Dr. Estima: Well, I think that, um, when we are thinking about.

D disability in any way. So I'll start actually with autoimmune, 'cause you mentioned thyroid. 

Dr. Brighten: Mm-hmm. 

Dr. Estima: Um, one of the ways that I will counsel anyone with an autoimmune condition, it could be hashies, it could be lupus, it could be ms, is you just have to dial down the intensity. Mm-hmm. 

Dr. Brighten: So 

Dr. Estima: what I often find in the autoimmune community, my it's, and it's usually women, is that at some point along the way, uh, that sort of internal GPS like our sort of in what we might call interoception or just our ability to sort of feel how we are doing on the inside.

Yeah. We're disconnected from that. So we, so often, you know, uh, uh, a woman with Hashimoto's will go into the gym and she will literally obliterate like she has no internal, like, Hey, you're working [00:23:00] too hard. And then she's like, and then I work out, and then I, I'm just down for the count for four days. Yeah.

It's like, okay. So you need to bring down the intensity. From whatever you, whatever that was, you need to bring it down 40%. Mm-hmm. So you need to bring it down to like a six or a five outta 10, because some stimulus, even though that stimulus might not be ideal, is still better than nothing. And we also have to have reverence for the healing that is, that that is required in the immune system, um, for you to eventually, if you're able to put into remission and all of those beautiful things working with practitioners like yourself.

Um, but right now it's like a yes. And like right now you just need to dial down the intensity a little bit. So for someone with a physical. Disability. I mean, for me, I feel like you, you're just going to avoid, you know, if you are wheelchair bound, let's say, and you're not ambulatory, so that you can't put a barbell, you can't get into a, you know, a leg machine.

You, if you have arms that [00:24:00] are working, then you can work on chest presses mm-hmm. And pullups and biceps. And so you, you're going to, you might not be able to work the, uh, the muscles that don't have that innervation to them anymore, but if you have any type of other. You know, muscles that work, then you can also train those up.

Yeah. I mean, we also see, like, I, I feel like in some ways when we look at the bodybuilding world, and I feel like I've learned a, I've competed in bodybuilding before, I competed in something called figure. Um, we can learn a lot from them. And then there's also things that I would never recommend, you know, everybody do because they're all starving when they get on, when they get on stage.

But, you know, off season, uh, when we look at, you know, shows like the Arnold or the Olympia or whatever, there are, there are wheelchair bound athletes there mm-hmm. That look absolutely incredible. And maybe they have one leg, maybe they have no legs, maybe they have just, you know, they have, you know, there's been some type of tragic accident to the spinal cord or, or what have you.

Yeah. But they're jacked everywhere else. So I think, uh, and they're [00:25:00] super, I mean, I always like, kind of my favorite part of the show is to watch some of these people who've, who've had these physical disabilities. Overcome. Right. And that's actually one of the, probably my favorite part of training in general is Yeah, sure.

The aesthetics and metabolic and mobility and menstrual all that's really lovely. And the, uh, the mental grit. Mm-hmm. The emotion, like how you learn about what you're capable of. And when you are voluntarily, you know, several times a week going to the gym and putting yourself in a very uncomfortable situation, uh, where you're approximating muscle failure, you actually really learn a lot about yourself.

You learn a lot. You have, and you develop, uh, dare I say like love, I mean, I know it's like a re it's like an active rebellion to love yourself as a woman in this day and age. But yeah, you, you start to fall in love with yourself. You're really proud of what you've been able to achieve irrespective of arthro tide or autoimmune [00:26:00] condition or physical dis whatever it is.

Uh, you start to. Have a, an appreciation for yourself that is just like, you can't, you can't buy that, you can't get that anywhere else other than like putting in the reps, putting in the blood, sweat and tears that go into it. 

Dr. Brighten: Yeah. Yeah. Well I appreciate you speaking that because the big reason why I ask that is because now that, you know, strength training and exercise has become so focal on women on social media, there's a lot of one size fits all going on.

Yeah. Where people are like, if you're not squatting, then this is how you're a loser. Right? Like, if you are not doing this. Yes. And it makes things not only intimidating, but less accessible for people and for people to understand wherever you're at doing the best you can and just starting can make such a difference in your health.

And that it doesn't have to look like I just am laughing in my head. 'cause I think about the, like you see them. The like 22-year-old influencer who's like, this is what menopausal women need to do. I [00:27:00] know best I like and don't make excuses and all this stuff. And I'm like, honey, once upon a time I got humbled too.

And your time is coming, but I hope you learn. 

Dr. Estima: Yes. So 

Dr. Brighten: close your mouth and listen more really fast. Yeah. Because it's a hard, hard road to learn it the hard way. 

Dr. Estima: Totally. And we love those influencers and you have, you know, and in some, you know, and, and I, I, I always, I'm like, okay, they have like the best of intentions 

Dr. Brighten: and they, they really do.

It's like, but it's also sometimes so grading where you're like, hi, you're doing harm, please stop. 

Dr. Estima: Yes. And you know, when you have children and then you deal with the sort of hormonal. You know, mayhem that is pregnancy and postpartum. And then, you know, we call parenting what I like to call just like 18 years of being, you know, sleep deprived.

Yeah. Right. Once you've done that, and then of course you have the pleasure and honor of having all your sex hormones go down to like 90, like 99, lose 99% of your sex hormones. Mm-hmm. Like, we'll talk then, you know? Yeah. Um, we'll, we'll have a conversation in like 20, 25 years, so. Yeah. 

Dr. Brighten: Yeah, 

Dr. Estima: yeah. 

Dr. Brighten: No, I, you know, [00:28:00] and I think what you said is like, we do love them because they are trying to inspire health Yes.

In people. Yeah. I just think, um, I, I think about it from the perspective of like, before I was like such an amazing parent before I was a parent. Yes. You know, I knew like, oh, oh, like this is what you should be doing. And once you became a parent, you're like, oh, yeah, yeah. Okay. So I know nothing. Yes. And I think that is a lot, you know, you and I have sat in a very privileged position of sitting with patients who have gone the road before us.

Yeah. And being able to hear and witness their story and. Study it. And so we knew what was coming. Like, you know, we had the prelude of the things to come. And yet I think because we don't normalize these conversations enough or because like, um, the only, like I will say that if you are a gym bro who like drags pen perimenopause and menopausal women, like then you're on my list, 

Dr. Estima: then you're shame on you.

You're definitely on my list. Because you know what women love? We love when men explain to us about our menstrual cycle and perimenopause. That's what we love the most. That's what we want more of actually. I [00:29:00] know. Is 

Dr. Brighten: it not so bizarre when it happens on social media? Yeah, and I feel like. Men have absolutely a place in women's medicine.

There's great gynecologists. Yes. Like all of that. But when it's the male influencer, who is, who's bullying everybody? I don't know. I just feel like at this age, I'm just like, I do not need to hear another man telling me what my experience should be. Let me have you listen to what the experience is. 

Dr. Estima: The other one that I love is like, well, there's no RCT for that.

It's like, lack of evidence is not evidence of lack. You know what I mean? 

Dr. Brighten: Oh yeah. I'm like, um, come on. Have you seen the funding that they allocate to us? 

Dr. Estima: Yeah. Like, or what about the tens of thousands of patients that we've spoken to? Like that doesn't count. Yeah. So because of sudden RCT with like one variable that they're manipulating in the lab Yeah.

For six weeks, you're telling me that like my patients, her story doesn't count. Like get the, get outta here, sit down. 

Dr. Brighten: Well, and that's the thing is that women do not have the time to wait for a study to validate our lived experience. Oh, 

Dr. Estima: good. [00:30:00] We. 

Dr. Brighten: Absolutely do not get enough funding. This whole thing of like clinical experience doesn't matter.

Like that used to always be a form of evidence until 2020. Right. And then it became this thing where it was like, unless it's a study, it really doesn't matter. Yes. And I'm like, you know, when you look at women, so I mean, what have we got? Maybe like a, a couple thousand studies on perimenopause. That's it.

Right? That's it. Do you, I'm there. I don't have time to wait for all of this. I was sharing in another interview. Uh, the endometriosis per patient is $2 for the entire year per patient. You get $2 of research funding, like that's disgusting. Something that's affecting 20, or excuse me, 200 million women.

Yeah. And you're gonna tell me that I have to wait for the randomized control trial before I do something to try to feel better, like jog on. I have no time for this. 

Dr. Estima: Yes. There's, uh, I don't know where I first saw this term, but it's like. Uh, they're called ebit. S like evidence-based internet. Trolls. Yeah.

Dr. Brighten: Ebis. It's like you ebit 

Dr. Estima: s that's all you are just EBIT s Yeah, yeah, yeah. 

Dr. Brighten: Well, and it's also [00:31:00] the thing of like, and you've never had to be face to face with someone whose hormones make them feel like their entire life is falling apart and 

Dr. Estima: who've been to four doctors before you mm-hmm. Who've all said to her, it's in your, it's not, you know, I, I, I think that the stats, and you'll, you'll probably know better than I, but I think that the average, uh, length of time for an endometrial diagnosis, I'm like seven to 12 years.

It's ridiculous. Oh yeah. For 

Dr. Brighten: endometriosis. I mean, I went 29. 

Dr. Estima: Yeah. Like, 

Dr. Brighten: yeah. I had horrible, painful periods. Um, got put on the 

Dr. Estima: pill. You such pill. Competitive person. You always like to win, don't you? You're like, I, it's 12 years. No, let me double that. Lemme double that. 

Dr. Brighten: So crazy is that like, I wrote the book Beyond the Pill and I was like.

We have to stop giving this, this mass symptoms. You can hide endometriosis. And then like, fast forward five years later and I'm like, it's me. Yeah. Hi. Oh my God. I wrote about me. They did it to me. Yeah. And I didn't even realize it. Um, you know, in part because, well actually a large part because I dialed in the nutrition, I did lifestyle so well, I did all of this stuff so well Yeah.

That it's like, [00:32:00] you know, I was able to live with it. But you know, when you look at something like PCOS, um, you know, that's gonna be two to three doctors and who knows if they're, even, once they diagnose you, are they gonna give you anything other than the pill? Maybe Metformin, right? That's another subset that I see.

Non-licensed medical providers? No, they're not even medical providers, but just people on the internet telling women with PCOS like, stop using PCOS as an excuse. You should be able to lose weight. And it's like these people are working so, so far. Just eat less and 

Dr. Estima: move more. That sort of garbage. Yeah, less move.

Yeah. Right. Like don't 

Dr. Brighten: eat fat. Like I, I was saying today during my talk, like I have been in the nutrition field for two decades to see that like we don't eat fat people and we only do cardio people and we don't eat grains people and we don't eat any carbs people. And like, yes. And I showed this plate and it's this.

I'm like, and it's always comes back to this, half your plate is vegetables. Quarter of it's gonna be protein, a quarter of it's gonna be your carbohydrates. It always comes back to the same thing. Right. But the [00:33:00] trends and the fads hit us. 

Dr. Estima: Yeah. And I, I mean, in the spirit of sort of honesty and transparency, I gotta walk some of that stuff back too.

So I was, yeah. You know, I talked a lot about fasting, uh, several years ago, and I feel, uh, and I think that I, I'll say, I think fasting is one of many tools, but I do think that it has a very high affinity for abuse. 

Dr. Brighten: Mm. Uh, 

Dr. Estima: especially when we are talking about women who have told, have been told of their life that like skinny is the ultimate destination.

Yeah. That it's, you are worthy when you thighs don't touch. Mm-hmm. Um, and so, you know, I sort of started with the fat, like the whole fat as a, you know, my love is like brain health. I'm like, oh, it upregulates BDNF and it helps all this thing. And so I was really enamored, um, with it for a long time. And then, um.

A lot of, again, like patients are our best teachers, right. It's like, well, when I fast, especially when I do like these multi-day fasts Yeah. Sometimes I don't get my period, you know? And I was like, huh, that's interesting. Yeah. Tell me more. The body's like, red flag. Yeah. [00:34:00] Yeah. Tell me more. Right. And so I think that, um, you know, part of my, and I, I still think that I'm, we all fast technically every day mm-hmm.

When we sleep. Um, but I've sort of walked back or maybe softened is a better way to describe my, um, evolving view on fasting. I think that, yeah. Um, for women specifically, if we're talking in a, in a, you know, female centric kind of point of view, um, I don't think that. Because of the high affinity, like I said, the high affinity for abuse.

Yeah. Um, and excessive caloric restriction that happens with fasting. I and, and in per, and actually, let's just bring this back to perimenopause for a moment. Uh, fasting, uh, very popular to sort of fast until noon and then break your fast at noon, then you sort of have this like 6, 7, 8 hour mm-hmm. Eating window.

Mm-hmm. But when you are in perimenopause, of course we have a propensity to become more catabolic, meaning things are breaking down at a faster rate. Yeah. Including your muscles. So overnight, uh, you know, your liver and your muscles are feeding [00:35:00] glycogen to the, to the brain and the body and the muscles are also breaking down somewhat too to give amino acids to the cells for the, you know, the reparative process that happens overnight.

Mm-hmm. Um, and so you actually need to break your fast b fast, you know, break your, you know, have breakfast, I would say for a perimenopausal woman almost immediately upon waking with some protein so that we can actually minimize that. You know, that catabolism that's happening, uh, in, in the muscles and the bones.

Dr. Brighten: Mm-hmm. Yeah. You know, two things can be true. Fasting has benefits. Full stop. Yeah. Fasting may not benefit you. Full stop. Like, this is the thing where I think we lack the nuance. Most of the research on fasting is done in men, and it is like, I love the biohacking world. Like they're so innovative. Like there's, you know, there's so much you can learn from them.

What I don't love so much is they're always like, this is how men are. Make it work for you. Yeah. And I'm like, sorry, my ovaries say no. Yeah. They say no to you. Totally. So, you know, fasting. I do, uh, you know, it is, is something that I do find can be [00:36:00] beneficial. Postmenopausal, uh, it can be beneficial. Yeah.

But it doesn't have to be that long of a window. When you look at the research, really, like a sweet spot can be around that 14 to 16 hours, which is literally just not eating two hours before bed. Yes. In a lot of instances. Yes. And then, you know, going to sleep, hopefully you're doing a whole bedtime routine and then, you know, waking up, like just closing the kitchen so your gut can do its job at night, doing its cycling, doing the sweeping.

And that can be enough where I think, and you know, you're right about the abuse, you know, we know, um, are you familiar with ProLon? Yeah. Yeah. I mean, they've got great research. Yeah, yeah. On like doing a five day fast that is medical, like that is to be done under a physician's supervision. And that's where I think things have definitely gone awry is that people are taking like, oh, well, fasting has these benefits.

Yes. And it may not be right for you. And five days is intense. Have you ever done that? Yeah, I've [00:37:00] done the LON 

Dr. Estima: protocol. Yeah. 

Dr. Brighten: I did it and I was like, I, I actually, I 

Dr. Estima: was unhappy on it. I'm gonna say I hated the food. 

Dr. Brighten: I hated, hated the food. Yeah, because you're like eating little crackers and stuff. Yeah. I felt like a 

Dr. Estima: hamster.

Like, I was just like, I'm gonna get this little, like, plastic wrapped olives or whatever it was day. I 

Dr. Brighten: was just like, I'm done. Yeah. And I will just water fast for three days. I am like, just like, I'd rather eat nothing than eat packaged 

Dr. Estima: food like this hundred. Like it's not happy a hundred. I couldn't agree with you more.

And I, and I feel like also women are like, okay. Fasting, uh, longevity, health span, autophagy, blah, blah. And it's like, okay, so I'm gonna do it more is gonna be more. Yes. Right? Yes. Yes. And I think that we can, um, fasting can be a part of everyone's toolkit. Yeah. And it doesn't have to hurt. No. It can be super gentle and we can do a 14 hour fast, we can do a 12 hour fast, we can do a 16 hour, whatever it is, uh, that works for you.

Um, and it doesn't have to hurt. I think that that's, and even same thing in the gym. It's same thing in the gym, I'll say too. Mm-hmm. Like, we are, like, you have to work out six days a week and it's for, it's like two hours. And if [00:38:00] you're there for, it's like, it doesn't have to be that way. You can have a very effective workout two times a week.

Mm-hmm. 45 minutes and you can get incredible. Like it doesn't have to be. Difficult. Yeah. It can actually be very simple. It's just what's more important than the how is that you're consistent with it. Mm-hmm. Right. And I think that a lot of us get wrapped up in like, doing things perfectly. We have to do it all in or we're not doing it at all.

And this like all or nothing kind of mentality, which I typically see, and maybe it's just like the patient population that I attracted because I am that personality. Mm-hmm. Uh, is that, you know, we often, when we ch when we have the, you know, the choice between all or nothing, we often will choose nothing.

Yeah. Because we're like, oh, if I can't do it all and I don't have all the, you need to ProLon fast. If I can't have real food, no food at all, I'll just, I'm just gonna water fast. Right. And that's, but we all do that. Right. Any driven, uh, individual, male, we all do that. And so I think just a little bit of, uh, and I say feminine energy, not, I'm not talking about sex or [00:39:00] gender.

I'm just talking about when, you know, masculine energy, 

Dr. Brighten: the yin to 

Dr. Estima: the yang. The yin to the yang. Exactly. So I'm just like a little bit of softening, like I'm just gonna do something. A with a little less of an extreme amplitude. Mm-hmm. But I'm just gonna spread it out over, you know, a longer wi like a longer time, uh, is probably gonna get you better benefits.

You're gonna stick to it longer. 'cause humans can do anything uncomfortable for a short amount of time. Yeah. We can do a five day facet sucks. Um, in your case two days, right? No, 

Dr. Brighten: no. I stayed with the five days I did. Oh, you just went water. Oh, you just water fed. Okay. Okay. For that. And just so people know, we're not recommending this, I feel like, you know, you and I, we experiment with things and I was like, you know, if I was ever gonna re recommend this to somebody, I'm gonna try it myself first.

Like, I wanna see how it works. And it is something too that when it comes to luteal phase, I don't recommend fasting and I would never do that in the luteal phase. Yeah. As we know, progesterone is gonna make you slightly insulin insensitive. Yeah. And then your caloric needs can be elevated as well. And so yeah, that's [00:40:00] the other layer that I think gets missed too is people being like.

You know, cyclical hormones aside, it doesn't matter. Just dive in. Do this thing. 

Dr. Estima: Yeah. Just white knuckle it no matter what. 

Dr. Brighten: Yeah. Yeah. Since we're talking about food, is coffee with collagen a breakfast? If that's 

Dr. Estima: all you have time for? Yeah. Yes, of course it is. I actually had a, an ob, GYNI was, I put up some, uh, 'cause I'm a nerd, I had put up like a Star Wars, um, meme and it was, um.

F Okay. Just humor me. No, wait, humor me for a moment. No, 

Dr. Brighten: wait, I, I just have to say that. I love that. Oh my God. So I was actually on a podcast one time and they were all, it was like all these girls and they're like making fun of this guy that she was gonna date because she was like, oh my God. He had like.

Star Wars stuff and like, that's so weird. And I'm just like, waiting wait and listening. They're doing soundcheck and everything and they were just like, oh, Dr. Brighten, like, we bet like, you know, you, you like would like turned out this guy with Star Wars. I'm like, I love Star Wars. 

Dr. Estima: I love [00:41:00] Star Wars. As you bring that 

Dr. Brighten: up.

I'm like, I love Star Wars. What? 

Dr. Estima: Oh, okay. So this was the meme. Okay, go, go. It was Kylo Ren. Um, and the scene, like the, you know the scene where he's in front of Hound solo on the bridge? Yeah. And then so Kylo Ren says to him, uh, I know what I have to do, but I dunno if I have the courage to do it. Right. Yeah.

And then of course, and we cry because of that scene. That scene was, I cried during that scene too. But so what I had done in that is like, I don't, you know, so it's a picture of Kyla Ren and then the meme is like, I know that I should eat food before I work out, but I just dunno if I have the strength to do it.

Yeah. That was like my stupid meme. Okay. No, it sounds too me. It's great. So I thought it was great. Yeah. I was like, I was texting you before, I'm like, I just want you to let you know that I'm laughing at my own joke. Like literally out loud. I'm like writing you a joke and I'm laughing to myself because that's.

Okay. Anyway. I will like that too. You're all done. So the meme, I put it up and then I had this ob, GYN, she's a friend of mine, and she was like, oh my God. But all I have is like collagen Yeah. And coffee in the morning because I just don't like to eat. Like when I work out in the morning and I actually feel really heavy in my stomach, I'm like, great.

Yeah. Then just do [00:42:00] that and then eat afterwards. So, um, you know, all else equal, if we're thinking about performance in the gym, uh, it does, the literature does seem to suggest that having carbohydrates and protein mm-hmm. Prior to the workout does seem to augment performance in the gym. Yeah. Your ability to, you know, your endurance and this can go for whether it's a cardiovascular, um, you know, uh, endeavor or you're training legs or back or like really big muscles, right?

Mm-hmm. You need some sort of cardiovascular endurance to do those big muscles as well. If you are like, listen, when I have that stuff, I have a brick in the bottom of my stomach. Yeah. I feel awful and nauseous. Then for the love of. You know, ice, don't do it. Yeah. Like, don't do it. Um, then just have your collagen with your coffee or your cup of coffee or whatever it's that you have in the morning.

And then as long as your, uh, I like to say total 24 hour, you know, carbohydrate and protein intake is on point, you really don't have much to worry about. Mm-hmm. If you're really, uh, you know, kind of a stickler, let's [00:43:00] say for like ga like gains with a Z 'cause we all want like the, you know, the muscle gains.

Uh, then like right after you come home or you know, you on your way out, if there's like a smoothie bar, get like a protein shake. Yeah. Right. Get some spinach and some blueberries and some protein powder in there, bananas, whatever it is. Um, and then have it afterwards, like in that peri exercise area.

Mm-hmm. Either before or after is gonna serve your muscles really well in replacing and replenishing the glycogen that they've used. Um, but yeah, collagen. With coffee is totally fine. Yeah. 

Dr. Brighten: So that's a big controversial when I'm a collagen with coffee person, uh, in the morning and I will see people all the time be like, that's not a breakfast.

And the thing is exactly what you said, I had somebody reach out to me and they were like, I out so early in the morning, I can't get up early enough and eat. Yeah. I'm like, well, I don't want you compromising sleep. I would not wanna see you compromise sleep because you feel like you have to get up Yes.

An hour and a half earlier just to digest your food. 

Dr. Estima: Yeah. 

Dr. Brighten: And I, you know, shared when I was in college, I was the 5:30 AM group fitness instructor. Do you think [00:44:00] I'm getting up, like I'm med school, like to get up at like 4:00 AM to try to eat? No. No. Yeah. And so it was like coffee with collagen that totally works.

And then you eat, you know, within that 30 minutes after your workout, try to get yourself food because if you hit that hangry crash, like you're not gonna feel good Totally the whole day. But. It's a, it's a controversial one and I think, you know, it's not discouraging people from eating actual breakfast is what you just said, but it's like, if this is all you can do and still make it to the gym, and I would just piggy tail on that, piggyback on that and say, and not compromise your sleep as 

Dr. Estima: well.

Yes. A hundred. I love, I love that you said that. The other thing I'll say too is there's technically an ideal time for everything. Like I work out in the morning because that's just the time that I like to do it, and I have to do it in the day. But if we were to really look at the literature, that's not the best time to work out.

It's, you know, the best time to work, the best quotes, best time to work out is somewhere between 11 and 11:00 AM and 1:00 PM. Mm-hmm. Core body [00:45:00] temperature has peaked. There's probably a meal in there. Yeah. Your joints are lubricated, but not everybody can work out at 11:00 AM mm-hmm. Or 1:00 PM mm-hmm. So we just have to make it work for our life.

Yeah. So if it works for you to work out at 4:00 AM 5:00 AM 6:00 AM. And you like to have a collagen with a coffee, like that's totally great. And then just eat later. That's fine. Yeah. 

Dr. Brighten: Well, and you also find that a lot of people prefer to work out in the morning because they're like, I'm more productive, I can focus better.

Yes. Yeah. Like it has a lot of benefits to the brain, but there's also just the piece of like, you know, I'm that person that like if it, if I say, oh, I'll do it later, I'll do it later. It's the end of the day. And then I'm like, I'm not doing it later. I'm not doing this. I'll do some yoga, but I'm not messing with my cortisol.

Yeah. 'cause I don't mess with my sleep. Totally. And I'm just somebody that like if I work out, because I don't want anyone to be like, oh, so you can't workout at night? You can if it works for you. But I'm someone that like if it's 7:00 PM and I do a workout, my body's like, I need six hours to wind down.

Thank you. And I'm like, yeah, totally. No, this does [00:46:00] not work for me. Yeah. 

Dr. Estima: Yeah. I think you bring up a good point there as well. I think for me, I really like to work out in the morning because I just find that I have the most energy in the morning, and then after I get home from the gym. For, at least for me, I can say that I need to get in my body in order for me to be very creative.

Yeah. And I can't like, I'll call it like meditate, cold. Like I can't just like wake up in the morning and meditate. Like I need to actually move a little bit. Mm-hmm. I need there to be some, um, I need there to be some movement. And I actually find that anytime I do any type of breath work, any type of meditation, it, I have the best sessions after my workouts.

Mm-hmm. And then also just we, we know from neuroscience that we typically have the greatest cognitive capacity for like, str strategy and creativity, somewhere between two to three hours after waking. 

Dr. Brighten: Yeah. So if 

Dr. Estima: you can also prime the motor cortex and the, and the, and the, I'll say the frontal lobe, which includes the motor cortex with [00:47:00] motor acti, like with movement.

Yeah. Uh, then you're also just gonna be priming the brain for better strategy, better thinking sessions, better planning sessions, better creativity. Mm-hmm. Creative sessions as well. So. 

Dr. Brighten: Yeah. Mm-hmm. We've been talking about diet, let's talk about protein, because very early on you were like, you know, how much protein that person had to eat to get those muscles.

Yeah. So let's talk about that. 

Dr. Estima: Sure. I think, uh, in the context of, of women, um, it is probably the one, it is the one macronutrient that actually goes up as we age. Mm-hmm. Um. We've been talking a lot about mechanically stimulating the muscle, like approximating failure and what that feels like and looks like.

Yeah. Um, and all the benefits that, that, that resistance training gives you. But we also can chemically, stimulate, stimulate the muscle as well. And that's in the kitchen, right? Mm-hmm. So that's through the consumption of protein. Uh, and this drives up a process called, uh, muscle protein synthesis. Uh, and by the way, I'll also just say carbohydrates again, not the devil.

Yeah. Uh, what they do is they [00:48:00] provide, or they prevent muscle protein breakdown. Mm-hmm. So the, the sort of equation for whether your muscles are gonna grow is like muscle protein synthesis, minus muscle protein breakdown equals total muscle gains, right? Mm-hmm. So you, you need both protein and carbohydrates there.

So just like, I know that a lot of women have like an. Not an allergy, like an actual allergy, but like we, you know, we're like, oh my god, carbs, like, I can't have bread. And it's like, no, you can totally have bread. I have a piece of sourdough bread every morning. 

Dr. Brighten: Yeah. It's also something too that women have been told, like, if you eat carbs, you're going to get belly fat.

Yes. If you like. And, and again, it always comes back to like, it's a very simple balanced formula. Yeah. And then depending on your output and where, and maybe where you're at in your cycle or what you've done in your day will gauge Yes. Like, I, I just, you know, the thing is, is that you can intuit what your body actually needs, but it takes some time to rediscover that because 

Dr. Estima: Yeah, 

Dr. Brighten: from the time [00:49:00] before we even enter puberty, puberty, we are told that our body cannot be trusted.

That it's being betrayed and that you always have to look outside yourself for validation. Right. And for expertise, because you couldn't possibly understand the body you live in. 

Dr. Estima: Yes. Well said. Really well said. Yeah. I love that. Um. So I think when we're thinking about macros, um, and we're thinking about how, what's another way that we can support our muscles mm-hmm.

And our bones, it's through the consumption of protein. I do have a bias around consuming animal proteins. I think you can totally, if you're vegetarian, you can totally get there. You just need to sort of watch cal calorie intake and you just have to do your sort of due, due due diligence to make sure that you're sort of getting the full compliment of immune acid.

It's also worked, 

Dr. Brighten: so I was a vegetarian for 10 years. Yeah. And it was, it was so much extra. It's hard extramental load to make sure that I was getting, I mean, and the amount of eggs I would eat. Um, but yeah, it was just a lot to think about. And I want, [00:50:00] I always want people to like set back and look at how much can they really take on, you know, because, uh, you know, there are vegans, there are vegetarians who feel like they, this is the way and everybody should be doing this and.

It takes work. If you want to be vegan and maintain your muscle mass, like there's some really famous vegans and not have your hair 

Dr. Estima: fall out, let's just, and not have your hair fall 

Dr. Brighten: out. Yeah. But there's some really famous vegans out there and people are like, well, look at them. They're an athlete. And I was like, um, yeah.

And like they're vegan, like a full-time job. Like damn they're eating is their entire personality and what they're putting out in the world and they monetize that. Please. Recognize, like what can you actually take on in your life? Like is this, is this feasible? And I think we need to give people permission that maybe it doesn't look like perfect or what your friend would say or anything, but you really stand back and you say to yourself like, it can I take this on?

What is my life [00:51:00] actually look like right now? Because I think, you know, I said this in the interview with Dr. Kerry Jones is like, why is it that we're constantly expecting more out of women? Why is it that we are like, you need to build resiliency. Like you need to do more, do more, do more. You're having problems.

I'm like, we need to sometimes stand, stand back and be like, you're doing enough. What can you actually modify in your life to meet your goals, to support your health and not have to do so much? 

Dr. Estima: This is a good question. I would say for anyone listening to the show, like, how can you have addition through subtraction?

Dr. Brighten: Mm. 

Dr. Estima: Right. Yeah. So we were talking before we got going. I was telling you about like some of the reason, like we paired down our house, we got rid of our, like we went from two cars to one car. Like we were kind of, how can we add through subtracting? 

Dr. Brighten: Yeah. 

Dr. Estima: And I would also say to your point, it's a capacity issue, like being vegan.

Like I said, it can be done. It, it, it, you can get your protein requirements in. Typically they have a lot, they have to supplement a lot with protein powders, which is [00:52:00] totally fine. I do the same thing with, with whey. Um. But it's, it's a capacity issue, right? Mm-hmm. So, um, my bias is typically animal proteins because it's simpler.

It's like, I know I'm getting everything and I'm getting, well, you can get all the 

Dr. Brighten: branch chain amino acids, all which, yes. Uh, so Reba listening, leucine, isoleucine, valine. If you don't got those three coming in, sarcopenic, obesity is chasing you down. Yes. The deletion of muscle cells and the infiltration of fat.

And the only way to acquire that naturally in sufficient amounts when you are in perimenopausal is bioavailable. Yes. Is biovail is animal protein. And so if you don't wanna go that route, you're going to have to work harder to get those. 

Dr. Estima: Totally. And just kind of building on leucine. Leucine is the four woman that is, if Leucine was a girl, lucine would be the one that's like.

We got leucine coming in, start making the muscle ladies. Yeah. Right. So, uh, animal proteins are typically quite rich, uh, in leucine mm-hmm. Where we, and then we would see like plant proteins are often quite [00:53:00] poor. Yeah. Um, and so leucine typically we need somewhere between like two to three grams, two to two and a half grams really of leucine to kind of start that MPS, like that muscle protein synthesis mm-hmm.

Uh, process. Um, and so when we look at the bioavailability even of just like. You know, so if we look at animal proteins, it's usually somewhere like 96, 7, 8, 9% bioavailable. Yeah. The one thing I will say is, uh, soy does tend to be actually quite bioavailable as well. Mm-hmm. So if you're consuming like a soy protein, um, I think that the literature is something like 94, 95.

Like it's, it's as, it's comparable in terms of bioavailability. 

Dr. Brighten: Yeah. But 

Dr. Estima: if you look at a rice protein, uh, a pea protein, these are like 20. 30 some like maximally, 40% mm-hmm. Of the protein is bioavailable to the human body to break down because of the way that just the protein is sort of attached, uh, in a plant protein is different than in an animal protein.

So it makes it much difficult for the human body to sort of break those down and assimilate the amino acids in a way that we need. Yeah. You kind of get the ones that we need. [00:54:00] So you have to ask yourself, okay, so if I'm having this pea protein and it's like 40% by like, how much more pea protein do I have to, and like protein in general, and how much gas may you have and how much, yes.

How tolerant is your family to GI distress? Right? Yeah. That's like the question too that we wanna ask. Um, so yeah. Uh, so for me, animal protein is just like easy. I also supplement, like I said, with whey protein. Mm-hmm. I think that every woman should get in touch with her inner protein shake. Uh, you know, if you can't, a lot of women will say, oh God, like I, it's so much protein.

I'm trying to get in so much protein. He's like, yeah, you can also just like put a scoop and a half mm-hmm. Mix it in with some Greek yogurt and you have like 50 to 60 grams of protein in that, in that bad boy. So that, 

Dr. Brighten: that's what I do for breakfast. And then I'm like sipping collagen in my coffee. Yes.

And 

Dr. Estima: I'm like, well, and that's why you have the skin that you do. Yes. 

Dr. Brighten: Yeah. That's where it's at. Yeah. So when people are looking at protein intake, how much protein should be, should women be consuming at this phase of life? 

Dr. Estima: I would say, um, as a [00:55:00] general target, um, certainly there can be individual variances, but I would say a general target is one gram.

Per pound of ideal body weight. Mm-hmm. So the ideal body weight piece is a little important to just pay attention to. So if you're, let's say you're, I'm just gonna pull numbers outta the air, like you're a hundred and, I don't know, 80 pounds, um, but you know that you're gonna feel a lot better at 150 pounds, let's say.

Yeah. So you're gonna probably try to aim for 150 grams of protein. Mm-hmm. Now, 150 grams of protein is a lot if you have been consuming 60 or 70 grams of protein Yeah. Previously. And the other thing, of course, uh, with perimenopause and just the natural course of aging is that single, like, that epithelial lining of the, the, of the, of the gut kind of gets shredded with age.

Right? Yeah. Yeah. 

Dr. Brighten: No, that's actually what I presented on today. Okay. Was like the decline in estrogen and how that compromises gut health integrity. 

Dr. Estima: Okay. So, you know this again, uh, is that. It's very difficult for like a 47, [00:56:00] 52, whatever year old mm-hmm. Woman in perimenopause just all of a sudden double her protein intake.

So, and, and again, the gas, the GI distress, all of that stuff. So I would say, yeah. Before changing anything, just look at what you're consuming now. Maybe it's 60 gram, whatever it is, it doesn't matter. No judgment. Mm-hmm. It's just, it is what it is. Baseline. And then you can just start slowly titrating up.

Yeah. Just again, just a nice easy grading. It doesn't have to be extreme. We don't go from 60 to 150. Mm-hmm. We go from 60 to 70 and then we stay there for a couple weeks, we feel good and we say 70 to 80, and then you stay there for a couple weeks and on and on and on. Right? Yeah. And so this is a way that I think we also show ourselves reverence and we show our body that we are willing to give her the time to adapt to the stimulus that we're providing her.

Dr. Brighten: Mm-hmm. 

Dr. Estima: Um, and we're not forcing an outcome that's at this point in time, not natural for her. 

Dr. Brighten: Yeah. Yeah. 30 grams of protein for breakfast in the morning. What are your thoughts? Love it. [00:57:00] Yes. Love it. Thumbs, thumbs up. Thumb. Yeah, thumbs up. It's good. Yeah. Oh yeah. And so take us through like a, like a, you know, in a day, what could somebody if, because I just imagine someone's listening to this and they're just like protein, like I've never even thought about protein.

Like, this is so much like to start with, it doesn't have to be exact grams, but just taking us through like structuring a day, like breakfast, lunch, dinner. What could someone be thinking about adding in at those times? 

Dr. Estima: Yeah, sure. So I can kind of give you just an example of what I do, uh, in a day. I love to have, I usually have something like five to six egg whites and an egg, um, in a kind of an omelet.

Mm-hmm. I put that on feta and a sour piece of sourdough toast and about a cup of berries. So my favorite kind of berries or blackberries, as my husband knows, uh, blackberries, whenever he brings blackberries home from the store, I'm very happy. Yeah. Blueberries as well. Um, I just love dark berries, but I also love, like, I kind of go through times where I'm like, all I want is mango.

Just give me the man, the frozen mango. That's all I want. So anyways, but a cup of berries, [00:58:00] uh, lunch is something like a four or five ounce. Uh, you know, chicken or ground beef or whatever, whatever. Mm-hmm. Uh, protein. And then I'll usually have some sauteed, uh, or air fried like, like, uh, cauliflower, broccoli or Brussels spells.

Those are sort of the, and mushrooms. Those are sort of the four vegetables that are in high rotation in our home. 

Dr. Brighten: Yeah. 

Dr. Estima: And then I actually also have, for dessert, I have more fruit. I love fruit as my dessert. Mm-hmm. And then depending on, uh, kind of what's going on in the evening, like I have soccer runs and there's martial arts and all the things that happen in the home in the evening.

Sometimes it's honestly like, it's just like a tub of cottage cheese. Yeah. That's like what I got. And it's all, I got time that for 

Dr. Brighten: it, that sometimes my breakfast, I'm like, I'm just gonna eat the cottage cheese. Yeah. And it's like already in a 

Dr. Estima: tub and it just like, whatever. So that's like, I don't know what it is.

I, I've worked it as like 60 grams usually of protein in that tub. Mm-hmm. And it's about 360, 400 calories or whatever. Um. So it's either cottage cheese or like what we were saying before. It's like some Greek yogurt. I'll put some chia seeds. Yeah. And I have like sunflower seeds or whatever seeds I [00:59:00] have.

Um, and I'll put maybe some honey and then I'll mix that in with some protein powder and I'll make it like a chocolate flavor, let's say. 

Dr. Brighten: Yeah. 

Dr. Estima: Um, and that will, you know, that's, you know, I'm usually somewhere in the, I have a little bit more than my body weight, uh, in protein just because I enjoy it and I train hard and I need the recovery, but mm-hmm.

I'm probably having somewhere between 150 to 160 grams Yeah. Uh, of protein on a given day. And, but you can kind of see how I've like very easily racked that up. Like one meal might have 60 grams of protein in it, so. 

Dr. Brighten: Yeah. Well, I appreciate you taking us through that because that's what I wanted to be illustrated is that it's not actually a lot it, because it sounds, when you hear 150, it sounds.

So huge. Yeah. Yeah. And yet when you go through the day, there's, you know, easy ways to achieve that. I'm a like canned salmon person. I can literally, oh, that's another 

Dr. Estima: great one. Literally eat 

Dr. Brighten: salmon salad like every day of my life and be happy. Yeah. Um, and that's another way, just like really easy to get more protein.

And sometimes I'll even make it with [01:00:00] Greek yogurt instead of like a mayo. Um, I only eat avocado based mayo because I was that weird kid who never wanted mayo. And then that came out and I was like, I can tolerate this. Hmm. But otherwise, um. Greek yogurt is a way to just like bolster it up and then you do a lot of herbs and things in it, but it is awesome.

Not that overwhelming when you actually just break it down. If you've gotta go from 150, divide by three if you're eating three meals a day. Yeah. And then start to work from there. Um. So when you say carbohydrates, I think people automatically think grains. Mm-hmm. When you're talking about eating for carbohydrates, what kinds of things can people, uh, consider and how should they be timing these things?

Dr. Estima: Well, it's kind of what you said, like half your plate should be vegetables. Vegetables. I know it's a new splash for some, but that's a carbohydrate. Yeah. Those are carbohydrates. Um, so I would say that the first line, like first choice is gonna be half of your plate being, I love green leafy vegetables.

Kayla's your friend. Don't listen to people who talk in the grocery store that tell you [01:01:00] kale is like, you know, gonna kill you. Its like not kale's not gonna kill you. 

Dr. Brighten: Oh, the way I love kale's so much too. Yeah. Oh yeah. And let me just say, because I know you're gonna comment, it's someone out there, the ERNs will not get you massager, kale add acid, but you would have gi distress before you could eat enough cruciferous vegetables.

And the ox plates is like, you know, just 

Dr. Estima: steam, just just steam 

Dr. Brighten: the 

Dr. Estima: spinach 

Dr. Brighten: and you're good. I, you know, it's funny you say that 'cause I actually had someone today that's like, I can't believe you eat spinach that's high in oxalates. I'm like, my kidneys are good. All right. Like, I'm okay. Thanks for checking in on me.

Me, it's like we already 

Dr. Estima: have trouble consuming vegetables as a society. Yeah. So these, again, often bros who are like doing these videos in the grocery store, they're like, this broccoli's gonna kill you. Yeah. Or, and it's like, it's not 

Dr. Brighten: Well, and that's, it's a really important point for people to listen to is that whole foods being demonized is so, so problematic.

It's such a problem. And I don't even understand it. It's [01:02:00] like most people aren't even consuming whole foods in the United States, and now you're gonna scare them in the grocery store of being like, oh, tomatoes were designed to kill you. And I just laugh. Like I, I had somebody that was like. Um, I used to respect you, but I'm not gonna follow you anymore because I cannot believe you're eating corn tortillas.

And I was like, I'm a Latina. What did you expect from me? Yeah. So I'm gonna, I was weaned on s this, I'm eat salsa. You don't understand. I drink salsa. Like, 

Dr. Estima: and also, um, nutrition has become very religious, very cult-like. And there's these carnivores better than, and then there's carnivore wars and vegan wars.

Yeah. And keto wars and whole food. 30 and all the, all the things. And I think, um, it's almost replaced religion, right? So as we've become more, uh, uh, of, you know, of a society that, you know, we don't go to and we don't ha, we're not as affiliated with the church as we once were, good, bad, or otherwise. Uh, I think that there's been an opportunity for [01:03:00] nutrition to almost.

Dr. Brighten: Replace that. It's seeking an ingroup. Yes. It's wanting to be an ingroup. And in some ways it's like, well, you know, this is like holier than thou, right? Yeah. It's better than these other people. So by association, I am also right. Better than other people. Right. And the people don't wanna be in the outgroup.

And that's understandable. When I was getting my nutrition degree, they actually told us, I remember like day one orientation, they were like, the most inflammatory things that will get you the most hate in the world is politics, religion, and nutrition. So now if you're going into this field, it is gonna be as rough as being a politician, right?

Or as rough as like trying to like, you know, persuade someone into a religion. And I was like, wow. Facts. Yeah. Good chat. Good chat. Good chat. Yeah. 

Dr. Estima: Yeah. I think, um, I think we do have to release some of the dogma there and you know, a lot of the literature, I mean we could, maybe this is a separate topic as well, but like a lot of the nutrition science is like really terrible.

Mm. It's like, Hey, what'd you eat last month? It's like, I can't remember what I had two [01:04:00] days ago. Yeah. I'm gonna write a journal of what I had last week. There have 

Dr. Brighten: been studies, so many studies that have shown that recall the recall diets do not work. Yeah. And also, especially on people who. Are gonna feel judged and they don't want to let you down.

They don't want you to judge them on their diet. Mm-hmm. And so you'll see a lot where people are like, I had the perfect diet. Even if you're like, oh, I want you to keep a three, three day diet. Like I wanna see what you eat over three days, they will eat their best diet over those three days. Yes. 'cause you're gonna look and they don't wanna be judged.

Dr. Estima: Right. Yeah. Or they'll leave out. I mean, there's that and there's also, well, I'm gonna leave out that I had the thing of Haagen-Dazs at the end of the day. Yeah, yeah. And like that I finished off the chips or the cookies or the cra, whatever it is, crackers and the pantry, like all of that stuff doesn't make it into those surveys.

Mm-hmm. So that data is just incredibly flawed. Yeah. Um, and it's very hard to draw definitive lines in the sand. [01:05:00] Mm-hmm. Um, with such weak, weak data. Yeah. 

Dr. Brighten: And I will also say, as someone who. Did nutrition science research is that there are people who will fund your research and they absolutely do influence outcomes.

Yeah. And anybody who's like, it doesn't matter who funds the research, it doesn't have any effect is lying. Mm-hmm. Um, or they just don't know. Or they live in la la land and I like it there, maybe I'll join you. Um, but they do influence outcomes. Even, uh, when you look at nutrition schools, there will be something like Pepsi's the one who donates.

So we don't talk about Coca-Cola in our program. Right. Or whoever is funding and donating. They will influence the curriculum. It's why the American Dietetic Association has had so much criticism because it is controlled by big food. And that's why like, shout out to all the dieticians out there who really like fight [01:06:00] against that to do right.

By people because Yeah. And I wanna just be really clear because I think it gets wrapped into like, oh, well the a DA, it like has this level of corruption, therefore dieticians are not good. No, dieticians are amazing. It's just we've got issues with governing body. And that's actually like, was a big influence of why I was like, I am not going, I studied the whole science and didactic route and I was like, no.

Mm-hmm. I, I see what's happening there and I have no interest in playing that game. 

Dr. Estima: Yeah. Yeah. I think, um, when we're just thinking about how to build a plate, it's like, just choose whole foods, half the plate. Like you said, half the plates gonna be veg. Uh, I do think carbs, um. There's a place for pasta and rice and potatoes.

Um, big fan. Have them often. Yeah. Uh, you know, so there's not, there's, I feel 

Dr. Brighten: like I was just in Italy. Big fan. Yeah. Big fan. 

Dr. Estima: Thumbs up actually. Um, maybe we'll talk about this another time, but I also find that, and this could be just, uh, an ag issue or what they're spraying versus what they're not spraying and the wheat varieties and all [01:07:00] the things.

But I can have gelato and pasta Absolutely no issue in Europe. Yeah. At large. But in Italy it's like, I feel actually great after having gelato. Yeah. And here I, I actually don't really have it because I don't feel good. 

Dr. Brighten: I've been trying to, I, you know, there's not research on it. I've tried to figure it out.

'cause people will always say, oh, well when you go on a vacation, you're so much more relaxed. Mm-hmm. And to that, I'm like, if I eat gluten in the US at any time. It, uh, I get inflamed. It affects my joints. I have psoriatic arthritis. I fill it. Mm. And they're, and they're, you know, I talk about like, oh, in Paris I can eat, you know, a baguette and I'm fine.

And people are like, that's 'cause you're there and you're relaxed. I'm like, well, I lived there. Mm-hmm. When my kid had pandas, it was literally the most stressful time of my life. Yes. And I still didn't have issues. Yeah. 'cause the bo lingerie is like regulated in a way that the FDA could never Yes. Um, French are very serious about their food, but it is, I'm like, there's something more to it.

We don't have the science to validate it, but if people are telling me, this is my experience, that's your truth. You live in your [01:08:00] body, you know best. 

Dr. Estima: Yeah. Yeah. And there's even, um, I actually just learned this recently that there's, if you wanna call the baguette like a traditional baguette, it's like it has to just be water and yeast.

Mm-hmm. And, and that's it. It has to be baked that day. Yeah. It cannot be like yesterday's bread. Uh, and then it has to, you know, you can tell, and there's another type of baguette, I forget the name of it, but it's like, um, I forget the name in French, but it's, there's like the real baguette, which is like, has Cru that crusty Yeah.

Yeah. Outside. And when you break it up, it's like all these little holes in it from the. From the yeast and all the things, and then there's sort of the, the baguette that's just, you know, ba baked whenever it doesn't have the crusty, it's the wonder bread 

Dr. Brighten: of baguettes. It's the wonder bread of 

Dr. Estima: That's one.

Well said. Yeah. Yeah. It's the Wonder bread of baguette. So, uh, the French, I think Europe, at at least my, I've traveled mainly in Western Europe, so I can't speak to Eastern Europe, although I'm, I'm sure it's very similar. Um, but the western, the countries in Western Europe that I have, um, visited, I. Always feel better there.

Mm-hmm. 

Dr. Brighten: I 

Dr. Estima: always feel better. I can [01:09:00] have all the things that generally I'm like, uh, ice cream, uh, like, mm, maybe I have a bit of a lactose intolerant or something here that that disappears mm-hmm. When I cross the ocean. 

Dr. Brighten: That's so interesting. But there, I know there's people listening to this. They can leave us a comment if they're a part of that, but there's so many people that have that experience as well.

Yeah. And again, it always just gets chalked up to like, Hmm. It's just because you're relaxed now you're not stressed. And I, I will say that's something that I was like, yeah, that makes sense. That makes sense. Mm-hmm. Until like, you know, if, if people they can listen to my interview with Dr. Elisa's song, I'll link that.

Um, talking about pandas. But she's the best by 

Dr. Estima: the way. She's the best. She's the best, right. 

Dr. Brighten: Yeah. Uh, but yeah, it was the hands down the most stressful time in my life. And I'm like, and yet the baguette and I still besties. Still besties. Yeah. Didn't have a 

Dr. Estima: problem. I think. Um. The government, I think that the, the pride in their heritage, pride in their food mm-hmm.

Does seem to trickle [01:10:00] into their laws and regulations. Yeah. Where I feel like in Canada and the United States, um, can I say this? I feel like they don't care for, they don't care. Mm-hmm. Not protecting their citizens. They work for some of these big food and big ag, um, companies that, and they're, it's about profiteering at the expense of the 

Dr. Brighten: Yeah.

Dr. Estima: Our children. Yeah. 

Dr. Brighten: And absolutely is. I mean, I think anybody paying attention understands that to be true. And it's why we're seeing, and, and we've had a big movement for a long time to really 180 of those things. And I think, you know, in the same vein of this conversation, what. You said, it's so empowering for women to hear of like, choose whole foods as often as possible.

Yeah. And you'll be making the right choice whether, and, and gauge how it, how you feel in your body, but ignore all the outside noise and listen to yourself, have your own experience and understand what's true for you. 

Dr. Estima: And the [01:11:00] other thing I'll say is, let's say you didn't choose Whole Foods today. 

Dr. Brighten: Mm-hmm.

Dr. Estima: Let's say you did the, the Haagen-Dazs, you did the pantry, cleaned out the pantry. It's like one day. Yeah. It's one day in one week of many. And often the. Uh, the rumination and the self, uh, depleting and derogatory talk is more damaging Absolutely. Than the actual food that you ate and the caloric surplus maybe that you had and whatever.

So it's like, yeah. And have whole Foods most of the time. And if you're at a wedding or you're at a celebratory or you just, or whatever, it's a Friday night and you're like, I want a pizza. Yeah. Like, have the pizza and it's okay. Next day you're gonna have all that glycogen. Just go into a leg workout. You know, you're gonna have the best, you're gonna have the best workout.

And even if you, okay, let's take it. Let's take it one step. F you don't do the leg workout the next day. Who cares? 

Dr. Brighten: Yeah. 

Dr. Estima: It's one day. 

Dr. Brighten: It's one day. [01:12:00] Yeah. That is a great place to wrap this conversation. I could talk to you forever. 

Dr. Estima: Yes. 

Dr. Brighten: But we sadly do have to conclude this. Thank you so much for sitting down with me, sharing this conversation, sharing your knowledge with everyone.

Dr. Estima: It's just a delight to spend time with you. So thank you for inviting me here, and I'm so grateful for you. Thank you for having me. 

 

Dr. Brighten: Aw, thanks. I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.