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Exercise, Training, and the Influence of Female Sex Hormones with Lisa Costa Bir and Dr. Stacy Sims

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Exercise, Training, and the Influence of Female Sex Hormones with Lisa Costa Bir and Dr. Stacy Sims

Dr. Stacy Sims, expert in female physiology and training, collaborates with fx Ambassador Lisa Costa-Bir to discuss the intricate relationship between hormones and physical performance.

Together they explore how the female hormonal cycle introduces unique challenges and opportunities. The follicular phase is the time when women typically excel physically, while the ovulatory phase can bring variations in how one feels during exercise. The mid-luteal phase can be challenging for high-intensity training, and the days leading up to menstruation require tailored adjustments due to mood, heart rate, and performance changes.

Tailored exercise strategies are discussed, with tips for conditions like endometriosis and PCOS. Maintaining muscle mass during peri/menopause through specific exercise approaches is emphasised. Hormone Replacement Therapy (HRT) is clarified as not reversing aging but preserving lean muscle mass through exercise.

The podcast also covers injury prevention, nutrition, and hydration strategies, offering women and clinicians an holistic guide to optimise their fitness journey throughout life.

Covered in this episode

(00:27) Welcoming Dr. Stacy Sims
(01:57) Phases of the menstrual cycle impacting energy and exercise
(08:15) How anovulatory cycles are affected in training
(09:41) Endometriosis and cold water immersion
(11:28) Heat exposure for adaptive stress in autoimmune and inflammatory diseases
(13:14) Training during Menopause and Perimenopause
(18:56) HRT
(21:37) Prevalence of injury in Perimenopause
(24:15) Cycling exercise throughout the menstrual cycle
(27:25) Protein in hormonal production
(31:16) Fasting in Perimenopause
(33:35) Carbohydrates for training
(36:23) True hydration
(38:45) Nutritional supplements for training performance
(43:51) Adaptogenic herbs for training performance
(45:45) Thanking Stacy and closing remarks

Key takeaways

  • Role of hormones and their impact on women’s drive to exercise and performance
    • Follicular phase (low overall sex hormone levels) - when women are typically most resilient and can perform physically at their best
    • Ovulatory phase – women can go either way – feeling “bulletproof” or flat
    • Mid luteal phase (where oestrogen and progesterone rising) – high intensity training is difficult but sustained exercise is achievable
    • 4-5 days prior to menses (where oestrogen and progesterone have peaked) – PMS, mood and sleep changes, heart rate change impacts performance and exercise can be adjusted
  • Adjusting exercise around hormone profiles:
    • Endometriosis – cold water immersion can help alleviate symptoms over several cycles, and there's no need for ice baths.
    • PCOS women – track cycles, adapt nutrition during inflammatory phases, and consider IUD or low-dose hormones for balance.
    • PERI-/MENOPAUSE - heavy strength training (fewer than 8 reps) to stimulate nerve response, compensating for low estrogen's typical role.
    • HIIT to reduce adiposity – 30-second work intervals and 4-minute recovery cycles helps burn carbohydrates and sugars without insulin response, also promotes cardiovascular benefits.
  • Hormone Replacement Therapy (HRT) doesn't reverse the aging process - HRT is metabolised differently from natural hormones which can have negative systemic effects, and reduced sensitivity of estrogen receptors can diminish its effects. Exercise maintenance during menopause is importance to retain lean mass.
  • Injury prevention for women throughout life stages
    • Ovulatory – oestrogen linked to elasticity of soft tissue, progesterone has an opposing effect so women can be more injury prone during early to mid luteal phase
    • Peri/menopause - good warm up, mobilisation/full range of motion, supplemental collagen and turmeric/curcumin can assist soft tissue health and counteract inflammation
    • Heat exposure is beneficial for recovery due to improvement in blood flow, reductions in inflammation and stimulation of protective heat shock proteins.

Precision tips on diet, fasting and macronutrients for women

    • Fasted training adversely affects women by inhibiting the mitochondrial use of free fatty acids due to glucose deficiency. Research suggests breaking fasts earlier in the day supports lean body tissue vs late fasts that are obesogenic
    • Protein intake: 30-40g during training, 40g post-exercise in the perimenopausal phase, and 15g pre-exercise and 25g post-exercise during menopause. Aim for 40g of protein from diverse animal and plant sources at every meal.
    • Consider BCAAs if feeling fatigued to counteract excess serotonin exposure, as leucine competes with tryptophan absorption into the brain.
    • Carbohydrates are vital to access fatty acid stores. Consume 30g before intense training to support a beneficial stress response. Post high-intensity training, carbohydrates and protein are important, with a stronger focus on protein post strength training.
    • Stay hydrated by adding a pinch of salt or sugars to water for better absorption; 8 glasses of plain water a day is not ideal for proper hydration.

Nutrients and herbs for support women and maintaining vitality

    • Creatine: 3-5g/d benefits the gut mucosal lining, brain metabolism and mood
    • Vitamin D status: optimise for mood support
    • Iron during follicular phase and stopping at ovulation. Ovulation and training (3 hours post-training) increases hepcidin inhibiting iron absorption.
    • Adaptogenic herbs and mushrooms for vitality, cognition, stress adaptation and nervous system response
      • Siberian ginseng, ashwagandha, schisandra, maca, holy basil
      • Lions mane and reishii mushrooms

Resources discussed and further reading

Dr. Stacy Sims

Stacy's website
Connect with Stacy: Instagram | Facebook
Stacy's Books
TedX Talk: Women are Not Small Men: a paradigm shift in the science of nutrition

Cold water immersion

Journal: Effects of long‐term whole‐body cold exposures on plasma concentrations of ACTH, beta‐endorphin, cortisol, catecholamines and cytokines in healthy females
Article: Sex difference in cold perception and shivering onset upon gradual cold exposure


Lisa: Hi, and welcome to fx Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. fx Medicine acknowledges the traditional custodians of country throughout Australia, where we live and work, and their connections to land, sea, and community. We pay our respect to their elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

With us today is exercise physiologist and nutrition scientist, Dr. Stacy Sims, Ph.D. Stacy has directed research programs at a number of universities, including Stanford, AUT, and the University of Waikato, where she focuses on female athlete health and performance while pushing the dogma to improve research on all women. She's the author of ROAR, a book written to explain sex differences in training and nutrition across the lifespan, as well as over 70 peer-reviewed journal articles. And she's also conducted an incredibly inspiring and powerful TEDx Talk, Women Are Not Small Men, which has over 460,000 views. Wow. Welcome, Stacy. Wow, wow, wow.

Stacy: I didn't realise that about the TEDx Talk. I was like, "Oh, wow. Cool."

Lisa: So, so cool. I'm fangirling pretty hard, as you can hear. So, I'm very, very excited to have you here to talk about everything you know really.

Lisa: So, I thought we could start with just explaining what happens in a regular menstrual cycle for women, because if our listeners don't understand that, then everything else you talk about is not going to make sense. And I guess we have two phases in our menstrual cycle, the follicular and the luteal. And within these phases, we see these huge cyclical fluctuations in our concentration of hormones. And the research suggests, some of the things I've read, that in some cases, this hormone secretion can vary from 10 to 100-fold within that same menstrual cycle, which is wild. So, can you start by telling us about each phase of the menstrual cycle, and what's happening hormonally, and how that may impact a woman's exercise performance, both mentally and physically?

Stacy: Yeah, sure. So, I guess the basic idea is the female sex hormones, estrogen and progesterone, they affect every system in the body. So, as you're saying, the fluctuations, we start to see these differences. Some are subtle and some are very overt depending on the woman. But if we look specifically at a menstrual cycle, and we say day 1 is the first day of bleeding, and we go day 1 to about day 12 is the low hormone follicular phase. And then we have the ovulatory, kind of, transition phase, which is the estrogen surge is around day 12 or 13, and then it drops and they have ovulation. And then after ovulation, estrogen and progesterone start to come up again, and this is called the luteal phase.

So, when we're looking at stress and stress resilience from an immune standpoint, from a cognitive standpoint, from ability to adapt to training and other stressors, it's the low hormone phase, that follicular phase where a woman's body is really robust on taking on stress. So, we see this, like, women would say, "Oh, I had a really fantastic day in the gym. I set a PR. I was able to handle all of this stress. I had energy for my kids, I had energy for my partner." And then around ovulation, women will either feel bulletproof or they'll start to feel flat.

Lisa: Okay. Yes. I can remember that for myself.

Stacy: Yeah. So, it's kind of an independent transitionary phase where women will not quite understand what's going on unless they're actually tracking their cycle and they're like, "Oh, ovulation, every day 12, I feel fantastic. And then day 13, 14, a little bit off." So, it's understanding that you have this transition from low estrogen to a surge of high estrogen, then it drops again. So, that affects our neurotransmitters, our cognition, our reaction. And then after ovulation, progesterone starts to come up, estrogen starts to come up. So, then we have another transition of these hormones, and women feel more like, "I can't hit high intensities, but I can go forever." And it's because we've had an immune system shift where we become more pro-inflammatory. We see a change in our autonomic nervous system where we have a higher respiratory rate, we have a higher resting heart rate. We're not as robust enough as we were in low hormone to take on a lot of stress. So, things are a little bit flatter.

And then about the four or five days before a woman's period starts again, this again is another transitionary phase because we've reached a peak of estrogen/progesterone, and then they start to fall off. And that decrease is very individual, but we see with that decrease, this is where we have PMS and we see really poor problems with sleep. We see a lot of mood changes. We see heart palpitations in some people, really severe PPMD in some women. So, all of those things that are from, I guess, an ecologically valid standpoint of not feeling fantastic is true validity from the changes that we experience from these fluctuation of hormones.

Lisa: Yeah. It's so interesting and I think you've probably known about it for a while, but I think it's just kind of coming out in the literature and I think a lot of coaches, a lot of women have no idea why their performance and why they feel differently about themselves at different points in the menstrual cycle, why it affects their performance. I know that I had a coach probably five or six years ago who was kind of like, "Why are you weaker? What have you been eating? Or what haven't you been eating?" And I actually think it was more related to where I was at in my menstrual cycle than what I'd been eating and that sort of stuff.

Stacy: Absolutely. And this is the thing where we've been conditioned so much from the...and this is historical, so we know moving forward it's not the case, but historically from that patriarchal, linear, algorithmic idea of training where you should be consistent all the way through, these training loads, if you are recovering well, if you're sleeping well, if you're managing stress. But that is very much the male-driven algorithm of training, stress, and adaptation. When we start to bring in female sex hormones and the different hormone profiles that women have either naturally cycling, and OC driven, or maybe some women who have really times of estrogen dominance and maybe some endometriosis, all of these things affect how we respond to training.

And so, a lot of women will be like, "What did I do wrong? Why am I feeling so flat? Why am I not able to hit my metrics today?" And if you're tracking and you see that that happens every day 18 of your cycle, then it's so empowering to really realise, "Hey, wait a second. It's not something I did, it's how my hormones are affecting my systems." And if you're aware of that, then you can put things into play to kind of level the playing field. You either adapt your training or if you have something specific you have to do on that day, then you can put some nutrition interventions into play to knock that flatness back.

Lisa: I love that. Yeah. Knowledge really is power and is empowering too. So, you mentioned endometriosis. I'm interested to know, then, how this information applies to women who have a condition like endo, or even PCOS, where with PCOS they're having less of an ovulatory cycle. Does that impact performance?

Stacy: Well, they're different hormone profiles. And so when we have anovulatory cycles and we don't have a lot of progesterone, so we see luteal phase deficiency and a greater increase in inflammatory states because the body is stressed. So, with PCOS, we really want women to track their cycle and try to see what are the patterns and when they have more inflammatory stages or not so we can adapt nutrition to help with that. And if not, then we can look at things using an IUD, or some other very low-dose external hormone to help control that and get some natural cycles back. Because if you're using an IUD, it doesn't downregulate your natural ovarian hormones. But it just helps balance it a bit. But if you're looking at oral contraceptive pills, then that completely downregulates your own cycle and your own natural hormones, so, you're just reliant on the OC.

Stacy: Now with someone with endometriosis, we've done some really interesting cold water immersion research where women about four or five days before ovulation, and they're starting to feel the symptomology of endometriosis, we do cold water immersion to kind of dampen that inflammatory response and to reduce the endometrial hyperplasia. And we look at doing specific cold water immersion all the way through ovulation and about the five or six days after ovulation. And it really attenuates the symptomology of endo and reduces the severity. And over the course of three to four cycles of doing this, it's almost a non-issue.

Lisa: Wow.

Stacy: Yeah. So, we've seen women with really severe endo, and just by creating that cold water immersion and having almost an epigenetic response to that cold water through the habituation and the metabolic changes and severe response to that cold water, it really helps dampen inflammation and helps kind of dampen the responses of estrogen to create that hyperplasia without estrogen.

Lisa: That is so interesting. So, four days before and four days after. How long do they have to stay in the cold water?

Stacy: So, women, I know...women's temperature range is much more sensitive than men. So, it doesn't have to be that 0 degrees ice bath. We're looking at 12 to 16 degrees C, for up to the neck for up to 4 minutes.

Lisa: Interesting. And what about, then, hot temperatures, have you done anything with that, like saunas and things that?

Stacy: So, when we're looking at using heat for kind of environmental and adaptive stress, it doesn't work so well with things endo and PCOS. What it does do is it helps with autoimmune and more pro-inflammatory autoimmune diseases because then you're having a heat shock protein response, you're having greater blood flow responses. To see people who have chronic inflammatory aspects in their tendons and tendinopathies, if they're doing 15 minutes of heat exposure after their exercise session, it expands their total blood volume and they're able to get better circulation and helps attenuate those inflammatory issues that they have when traditional acupuncture or physio and stuff doesn't work.

But when we're talking about hormonal flux, for some reason, it's the cold that really helps. And the theory behind it is an adrenergic response. Because we're seeing estrogen's driven a lot or drives a lot of the adrenergic responses. So, we're attenuating that we're making it more sensitive with the cold, then estrogen doesn't have a strong play in it. So, we're still working on really digging into the mechanism behind it. But right now, what we're seeing from a whole-body response is really cool because it's given so many women their lives back.

Lisa: That is so cool. And especially, like, I love the low intervention nature of water therapy, so powerful. Okay. So, we've talked a little bit about endo and PCOS. What about in perimenopause and menopause? Because I think, again, this is another area that's receiving a lot more awareness, a lot more information. How can we help women here? Because we see changes in body composition, loss of muscle integrity, is it possible, and I hope you're going to say yes, to gain muscle mass in perimenopause?

Stacy: Yes, absolutely. And I love the fact that this conversation is coming out to the forefront. But I want to put a positive spin on it because right now when we're reading popular media, it's all about how bad it is, that there's never a solution. There is a solution. So, like I was saying, estrogen/progesterone affect every system of the body. And if we think back to puberty or we have daughters going through puberty, and we see all these physiological and mood changes that are occurring with the expression of estrogen and progesterone. We get to the other end of things, perimenopause, and we start seeing the change in the ratio of estrogen/progesterone more in ovulatory cycles. So, that means less progesterone, every system is impacted. And when we're in perimenopause, the body is under more of a sympathetic drive and more in a breakdown state.

So, when we're looking at what do we need to do to counter that, and to stimulate lean mass growth, and to reduce the serial adiposity, we need an external stress that is going to cause an adaptation within the body the way the hormones used to. So, the best way that I can really paint the picture of that is things like strength training. So, if we're looking at strength training, the initial aspect of estrogen stimulates the satellite cell of muscle. So, it stimulates muscle cell development. It's also responsible for how strong myosin bonds to actin, and so your muscle contraction, how strong that is. And it's also responsible for how much acetylcholine is held in the vesicles right at a neural gap junction. So, what that means is when you have a nerve stimulus come down and that nerve needs to stimulate muscle contraction, it has to cross over this little gap. And that is done through acetylcholine. So, estrogen's like, yeah, we need more acetylcholine.

Lisa: Oh my gosh.

Stacy: When we start losing estrogen and we start losing a certain ratio of it, this is where we start to see a decrease in power, a decrease in strength, a loss of lean mass. But if we do essential nervous system-driven type resistance training, so this is your power-based training, your really heavy loads, you're not doing your 10-plus reps because that's more ripping the muscle and trying and hoping that it repairs. We're looking at something that's going to create a nerve response. So, for lifting heavy loads, then you have a central nervous system response that makes the nerve go, wait a second, we need to stimulate more muscle, we need to stimulate a stronger muscle contraction and we need to make it fast in order to lift this load.

So, instead of having estrogen stimulate lean mass, and estrogen stimulate acetylcholine, and estrogen stimulate how strong that myosin binds to actin, you have a nerve response. So, this is that external load creating a different adaptation that gives you a better result when we lose that hormone. And then when we look at the way progesterone and estrogen kind of reduce the serial adiposity, when we start losing that, we need to do a really high-intensity effort. So, true sprint interval training. So, you're looking at 30 seconds or less, as hard as you can go, redlining almost. And then you have maybe four minutes of recovery. So, you've completely recovered again.

What this does is it stimulates the muscle to be able to utilise and pull in glucose carbohydrates without insulin. It creates more of the GLUT4 protein translocation. So, these are a kind of protein gates that allow glucose to come into the cell without using insulin. It also creates a crosstalk between the muscle tissue and the adipose tissue and the muscle tissues like, we don't need you, adipose tissue, stop being full. So, it's a way to alter body composition in a positive manner.

And then when we look forward from a cardiovascular standpoint, that high-intensity work is really fantastic for increasing vascular compliance, reducing CRP levels. We see better vascular control. So, it helps with blood pressure and it reduces things like plaque accumulation. So, it's really good for cardiovascular health because we know that one of the things that goes up with peri into post-menopause is your cardiovascular risk factors. So, those are the two big rocks. So, we have to look at the kind of training we're doing, and it's not about volume, it's not about doing it every day. We know that two days a week of heavy resistance training and then two to three days of sprint interval training, that's all you need. It's all you need.

Lisa: So, it's quite doable, isn't it?

Stacy: Absolutely.

Lisa: Okay. Fantastic. So, poor old estrogen, it's been quite maligned in the past, but it seems like it's incredibly important for everything really, but particularly for performance. But you've given us a different way to enhance our performance if we're experiencing that estrogen withdrawal that doesn't involve, I guess, HRT or anything that.

Stacy: Right. Right. And the thing with HRT is there's kind of a misconception that it's like the be-all-end-all because we're seeing so much information out there about menopause being female hormone deficiency syndrome, or if you take HRT, it's going to put you back how you were in your 30s.

Lisa: If only.

Stacy: I know, if only, right? But it's a different form of hormones and what your body naturally produces. It's metabolised differently. And the other thing that happens with perimenopause is you have a decrease in the sensitivity of your estrogen/progesterone receptors. And taking HRT isn't going to restimulate those. So, it's good, it's slowing down the rate of loss. It's good at slowing down the rate of the serial fat gain, but you have to put in the work to really make sure that you don't get the meno-body, you don't lose a lean mass. And I put it on that table of things as tools to get through perimenopause into menopause, but there isn't any one specific thing that's the gold standard. And unfortunately, people think that HRT is the thing to do.

Lisa: I love that you've highlighted that because I think that holistic management is really not discussed. It is kind of like, "Here, just take this and don't worry." So, that the exercise, the diet, the sleep just is really under-discussed really, isn't it?

Stacy: Absolutely. And it's frustrating as an exercise physiologist to see research where people just do exercise research, or just do nutrition research, or just do pharmacological research, but they don't put them together and they leave sleep out. And we know that, one, you can't out-exercise a bad diet, and two, to really invoke body composition change, you need to have nutrient timing to go with that exercise.

So, they're all together, right? And you can't really invoke really significant change if you're highly stressed. So, you need good sleep, you need good mindfulness, you need to bring that parasympathetic response up. All of those things come together. Especially when you get into peri and post menopause.

Lisa: Absolutely. So, with talking about perimenopause, I have so many patients that present to me with injuries during perimenopause. So, plantar fasciitis or, "I was literally just walking down the street and I rolled my ankle and tore my calf," and things that. So, they kind of had noted, "I'm pretty sure it's something to do with perimenopause, but I don't really know what's going on. I spoke to my GP and they said, 'No, it's just because you're getting older.'" But when you look at the research, we see that...you've spoken about it a lot today already, that the sex hormones influence our muscles, our coordination, judgment, reaction times. So, the research shows that exercising women, for example, report three to six times more cruciate ligament tears than men. I'm wondering, like, what do you think about this and how can women protect themselves, I guess, if they're more prone to injury at certain times of the menstrual cycle?

Stacy: Yeah. So, when we look at things like ACL tear, we see that there is a correlative response to having ACL around ovulation, and people put it into the fact that estrogen creates more elasticity. Well, there's also a counter-response from progesterone. So, that's often left out of the conversation. So, you look at a high touch, if you are loading appropriately when your body can take on stress, and you're doing lots of mobilisation and activation in the sessions in and around ovulation, you significantly decrease your risk of ACL tear.

When we look at what's happening when women are getting into perimenopause and having estrogen/progesterone ratios changing all the time, plus a greater inflammatory response because their body is in this systemic drive, you're tired but wired, there is increased risk for soft tissue injury. And we see part of it is that incredible systemic inflammatory response, but also people aren't moving as well because things are starting to get stiffer, their joints are starting to get stiffer. So, to counter it, we look at doing some true mobilisation work. So, you're using banded distraction in the hips and the ankles. We're doing a really good warmup. We're doing things like taking turmeric and collagen to help support the soft tissues. And it significantly decreases the risk for getting those soft tissue and those chronic "niggles" like plantar fasciitis.

Lisa: So, building upon that is a lot of discussion at the moment about cycling exercise with the menstrual cycle. So, if we note that we tend to perform better at that day 12, 13 to be doing all our more hardcore exercise, and then doing less of the kind of active stuff in the luteal phase like doing more yoga, Pilates, etc. What are your thoughts on that? Do we need to mix it up or can we just do the same thing?

Stacy: When you look at it as training being different to performance and we can use our hormones to maximise our training stress...because that's the idea, right? You go training to create a stress, to adapt to that stress to get fitter. So, when we're looking from those generalisations that are out there, that's not appropriate. We don't want to generalise because every woman's cycle is different, we know that women have three, maybe four, anovulatory cycles a year, so that can impact. So, if a woman is tracking her own cycle, including her bleed pattern, so she can see if there are any changes in the bleed pattern, which might cause worry, or she's tracking and she sees the days she feels flat versus the day she feels great, then she can definitely leverage those different days into what kind of training that she's doing. The misstep that's in that cycle sync conversation...and I do take blame for some of it for coming out initially and saying, "Hey look, we've got these immune system changes and these autonomic nervous system changes," but then it became you can't do anything in the luteal phase. No, no, no, no, no.

Lisa: That's not what I was saying.

Stacy: I know. I'm like, we're tracking our cycle and working with the way that our physiology changes within us. So, when you're tracking your own cycle, you know how you feel and you can start to see these patterns in your responses to training, to sleep, to stress. And that's how you can cycle sync. You can cycle sync your own training to your own cycle. But what I do for me is going to be different from what my daughter does for her cycle because they're different, right?

Lisa: Yeah. I love that. Love that. I know, I've often found that sometimes when I'm in my mid-luteal, and I think, oh, I'm not going to be very good today at training, possibly because the neurotransmitters are making me feel like that, then when I go and train, I'm actually...it's fine.

Stacy: That's it. And then on those days where you feel really flat, you can do something like take some branched-chain amino acids or essential amino acids. Because then you're having more leucine cross the blood-brain barrier, less tryptophan, which then decreases that serotonin overload, which happens when you have too much tryptophan or too much estrogen. So, it kind of just modulates and moderates how much serotonin is affecting you, which can help you not feel so flat.

Lisa: Would you see...what if you feel like maybe there's not enough estrogen and not enough serotonin and that's what's driving the lack of drive and motivation?

Stacy: Yeah. And so when we have that situation, then what we try to do is get people to eat more regular high-tryptophan-based protein. Because if we have more tryptophan, then again we're producing more serotonin. But then the other big thing is gut microbiome. Because we're seeing so many trendy diets that are more eliminatory. So, we're saying, "I can't have dairy, I can't have wheat." I might be doing intermittent fasting, but all of these things really disturb the gut microbiome. And 95% of your serotonin production comes from your gut.

So, if we're having dysbiosis, then we're not going to have enough serotonin either for all the functions that we want, especially brain function. So, it's stepwise. We look and say, okay, nutrient timing, we want high protein, we want to dose that protein regularly throughout the day, the meals. And we want that good gut diversity to increase serotonin production to help deconjugate estradiol and spit back out into circulation so you can increase the amount of oestrogen you have. So, those are the things that we were talking about earlier where people are just exercise, or just diet, but they're not looking at that whole picture and that interaction.

Lisa: Absolutely. So, going back to that protein, you talked about splitting it up throughout the day and is there a specific quantity that you suggest?

Stacy: Yeah. So, when we're looking at reproductive years, so women are regularly cycling or using oral contraceptive pill or IUD. We're looking at about 30 grams of protein post-training.

Lisa: Post-training?

Stacy: Yeah. Or splitting it 15 and 15 before and after training. And then at every meal getting around 30 to 40 grams. When we start getting into perimenopause and postmenopause, women are more anabolic resistant to both food and exercise. So, we have to increase that dose. So, perimenopause, we're looking around 40 grams post-exercise or 15 and 25. So, 15 before, 25 after. And at every meal, 40 grams. So, that's, a palm-and-a-half size portion of protein. And people are like, "What? I can't get that much protein at every meal." Like, well, it doesn't have to be a big slab of fish or meat. You can look and be like, "Okay, well I'm going to have some legumes. I'm going to have some seeds and nuts, and some lean meat, and I might throw in some edamame," and all sorts of things to really bring up that protein content.

Lisa: The edamame are ridiculously high in protein, aren't they? It's just shocking.

Stacy: Yeah, I know. And green peas. People are like, "What, green peas?" I'm like, "Yeah, you mix green peas and edamame, that's a fantastic protein source there."

Lisa: Yeah. Fantastic. I love that idea of splitting it up for me. Because I was thinking, "Oh my god, 40 grams after training," when sometimes you don't actually feel that hungry. I love the idea of actually just doing a bit before, 15 before, and the rest after, that feels kind of doable.

Stacy: Yeah. And I mean when you look at the recent research coming out about protein, and for women, one, you can't do fasted training, it just doesn't work. But if we are splitting up our protein, we get better post-exercise adaptation because you already have those amino acids circulating. So, the body's already ready to uptake the leucine into the muscle and really start the reparation when you stop and give it a second dose.

Lisa: I'm so interested in the fasting aspect because, again, in perimenopause when women's body composition starts to change, so many women are fasting, often, like, fasting until like 2:00, but training in the morning and, yeah, can you tell me more about that in terms of it being counterproductive?

Stacy: Yeah, so if we're talking about fasting and having this severe idea of fasting where people aren't eating until noon and so they're training fasted, this is where we start to see a significant misstep in body composition and gut microbiome. And we just have a lot of issues, especially in women. Because women, by the nature of being women, are already capable of burning fat and if we don't have any kind of blood glucose coming in, it actually inhibits our mitochondria from pulling in free fatty acids and using it. So, we need a little bit of blood glucose to actually keep everything fighting fit and working for us.

Lisa: Okay.

Stacy: So, then when we look at some of the most recent population research coming out about early versus late fast-breaking, so we see people who are breaking their fast by 8:00 a.m. versus those who are breaking their fast at 12:00 or after, those who break it early have better outcomes with regards to body composition, cardiovascular health, metabolic control. But when we're looking at those who break their fast late, they have more obesigenic markers. So, they tend to put on more body fat, they have less blood glucose control, they have more insulin resistance, they have more sympathetic drive. So, that's what we really have to consider. And we put it in that whole chronobiology. Like, you want to eat when your body is stressed. When is it stressed? When you wake up and you have to do stuff in the day. And if you want to really kind of leverage the advantage of the popular idea of fasting, then we do it time-restricted where you don't eat after dinner and then you eat at breakfast. So, normally...

Lisa: Oh, so hard.

Stacy: I know, normal eating. People with normal eating, but we forgot what that is.

Lisa: Okay. So, look, really good tips there. Important to eat before training. What about...we talked about protein. I'm really interested in carbohydrates because, again, poor carbs get such a bad wrap, but do we need to eat them before? Do we need to eat them after? Tell us.

Stacy: So, carbs are really important for women and we're seeing that...I mean, we have this conversation right now because the Women's World Cup is going on, about to finish. And the conversation of relative energy deficiency in sport and low energy availability. And we see that women who have low carbohydrate intake just exacerbate the symptoms of low energy availability. So, they get more hormone dysfunction that starts earlier and lasts longer. They have more sympathetic drive, they have worse cardiometabolic outcomes.

So, when we look specifically at women needing carbohydrates, it's so essential because, like I said earlier, your body goes through blood glucose quickly and taps into the fatty acid. We're not like men who tap into liver and muscle glycogen and use that up and then get into fatty acids. Our body preferentially stores that and saves it for kind of an emergency situation. So, for women having just 30 grams of carbohydrate before a cardiovascular intensive exercise session goes so far with regards to telling the hypothalamus, hey, you know what? It's okay. We can do this stress, there's nutrition available to hit these intensities to take on the stress and then recover from it. So, this is why nutrient timing is so important for women, especially when we're looking at protein and carbohydrates.

Lisa: And 30 grams is nothing, right? That's a banana and something else.

Stacy: Yeah. So, what is that, 120 calories if that? So, it's not a lot at all.

Lisa: So, carbs before, and then what about straight after training, any carbs then?

Stacy: It depends on what kind of training you've done. So, if you've done, like, a MetCon or something that's really metabolically active and fuel-depleting, carbohydrate and protein, really important. So, we're saying about 0.3 grams of protein with 0.2 grams of carbohydrate per kilogram of body weight post exercise and then have your real meal within two hours after that, or have your real meal right afterwards. If you're just doing strength training, the carbohydrate part's not as important, the protein is.

Lisa: Okay. Excellent. And then what about hydration? Because again, I feel like we just assume people are going to drink water, and I don't know if everyone drinks enough electrolytes. Can you give us some tips here?

Stacy: Yeah. So, with hydration, that was kind of how I started down this whole track. I was a thermoregulation exercise physiologist looking at sex differences and hydration. And then I got into fueling and a whole bunch of other things. So, when we look at hydration specifically, walking around all day with a water bottle and drinking those 8 to 10 glasses or trying to get a litre of water in a day is all based on marketing myth. And there's no real truth to that, especially plain water. What happens if we're just drinking plain water is the body's like, "I don't know what to do with this." You end up peeing it out. So, a lot of people are like, "I'm drinking all day and I'm peeing a lot, I must be hydrated." But they're actually urinating more than they're taking in. So, we talk about hydration we want just a little dash of salt in the water that we're drinking. So, it might be 1/16 of a teaspoon per 750 mil, so it's not a lot at all.

Lisa: Tiny.

Stacy: But that sodium is going to let you absorb that water. And we're talking about exercise, we need a little bit of glucose in there too. So, then you just add a teaspoon of pure maple syrup and then it's exactly what your intestines recognise as a physiological functioning hydration. So, then you actually absorb it, you don't pee it out, it goes into your blood volume, it goes into all the cells. It helps with true hydration. So, when we're talking about hydration, super important in the...hopefully summer's coming, you can salt your watermelon and put it in the fridge and have salty watermelon. It's great for hydration.

Lisa: Oh, yum.

Stacy: It's so great. And so it's just like looking at watery fruit and veg, adding a little salt, that helps with hydration. If you're thirsty, then don't just drink plain water, you’ve got to add a little bit of salt to really help absorb that fluid.

Lisa: Ooh, what a tip. I can't wait to...I'm training tomorrow. I'm going to go home and get into the maple syrup, salty water.

Stacy: Fantastic.

Lisa: I'll report back my findings.

Stacy: Great, great.

Lisa: Can you talk me through any supplements that you think might be great to assist women with their performance? I've heard a little bit about creatine. I don't know your thoughts on this.

Stacy: Creatine is something that I really push for every woman to take.

Lisa: Oh.

Stacy: Oh, yes. Yeah, I know. We have 70% of the stores that men have, and it goes beyond performance. So, we're talking about a very small dose of creatine a day, so 3 to 5 grams, it's less than a teaspoon a day. And over the course of three weeks, it totally saturates your body. And what that does, it helps with all the fast energetics. It helps with the mucosal lining of our guts, it reduces gut issues. It goes to the brain, it helps with brain metabolism. So, we see RTCs of women who are using serotonin reuptake inhibitors or creatine, and the women on creatine come out of depressive episodes faster than women who are on SSRIs. So, it's really kind of an essential nutrient. And now when we're looking at modern diet and there's more plant-based diet and there's less of an emphasis on animal products, people are getting lower and lower in creatine. So, it's one of those that, small dose, great, bodybuilding doses, not so much because this is when you start getting the bloating and the side effects that people talk about with creatine.

Lisa: That's what I was wondering because I had a partner a long time ago that was bodybuilding and using creatine, and I remember he used to...I mean I'm sure, obviously, it helped with performance, but my understanding was part of the use was because it attracts water to the cells and it kind of makes them look bigger. But I know they can also get bloated, but I guess that's with the higher doses that you're saying.

Stacy: Yeah. So, when we're looking at the higher doses for bodybuilding, they're also taking it...they're doing 5 times a day, getting up to about 20 grams a day, and they're taking with carbohydrate. So, not only is the creatine pulling water in, but carbohydrate when it's stored as glycogen also holds water. So, that's why you get this bloated effect. But that small dose of 3 to 5 grams, you don't hold on to extra water, you don't get the GI distress, you don't get all the negative growth side effects that people talk about.

Lisa: Fantastic. Okay. There's another one for me to purchase. Excellent.

Stacy: There you go.

Lisa: Any other nutrients or supplements that you can recommend?

Stacy: So, for women who have really bad PMS or PPMD, so really severe depressive episodes with PMS, it's a vitamin D status. So, we look at low levels of vitamin D, you're really perpetuating these issues. So, if you're someone who's in the Southern Hemisphere like we are and we're on a low latitude, and you might get some winter sun, it's still not enough. And then in the summer with our slip slap slop, we're still not getting enough. So, getting vitamin D tested and seeing what that is, and if you're on the low end, then taking a 2000 international unit supplement every other day, is going to boost your levels and get you out of that severe PMS. So, that's one thing.

And then for women who are always sitting on the low end of normal for iron, which happens to so many women, they're like, "I'm tired, but they say that I have normal iron, but I'm on the low end." That's not necessarily normal for you. So, we look at taking a supplement every other day during the low hormone phase, during the follicular phase, and then stopping in ovulation because this works with hepcidin. So, hepcidin is that hormone from the liver that helps regulate iron, and when hepcidin is up, you can't absorb it. Post-training, it's up for about three hours. After ovulation with the elevation of estrogen and progesterone together and the pro-inflammatory response that happens with the immune system, hepcidin also comes up. So, we look ideally every other day starting the first day of your period all the way through ovulation, and that boosts you up to mid-range instead of always staying at that low end of normal.

Lisa: Fascinating. Okay. So, hepcidin is up three hours post-training. Oh, so interesting. So, not the time to be having your iron supplement.

Stacy: Yeah. I always tell people, "You know what? If you can handle it, then take all your supplements two hours before bed." So, if you're looking at iron, hepcidin is a little bit upregulated in the evening, but not as much as post-training. And if you're taking it two hours before bed, it will have gotten through the digestive process. So, it's not going to interfere with parasympathetic responses. And it just becomes like, okay, you put it next to your toothbrush or something, so you remember to take it.

Lisa: Definitely. Okay. Last question. What about the adaptogen herbs? Because there's a fair bit of research coming out on them for improving training performance. I personally love Eleutherococcus, Siberian ginseng. I feel like when I don't take it, I don't know if this is psychological, but I'm always weaker and do a poor job. Have you used the adaptogens?

Stacy: I love adaptogens. They're very, case-dependent, but we know that there are at least six that have really strong peer-review research, Siberian ginseng, ashwagandha, schisandra, maca, holy basil.

Lisa: Love holy basil.

Stacy: Lion's mane and reishi mushrooms. So, they all work to decrease stress. We look at Siberian ginseng and schisandra as creating more cognitive focus and ability to push a little bit harder with regards to physical and mental acuity. We see things like lion's mane helps with brain tissue volume as well as the neural growth patterns. So it helps attenuate Alzheimer's and things like Parkinson's because it's a neurocognitive disorder.

And then for women who are, like, in perimenopause and having severe stress and just can't get out of that tire but wired, we look at using things like rhodiola and ashwagandha because then that helps decrease cortisol, helps moderate estrogen flux. And so there's so many great things about adaptogens, but like I said, it's a really case-by-case basis. Like, what are your needs? And let's look at what adaptogens we can use. And I put them on that whole table of tools in life that we can use and choose from to help us navigate all these hormone profile changes.

Lisa: Yeah. I love that idea. Amazing. Well, thank you so much for joining us today, Stacy. It's been amazing. I think all our listeners would have a much better insight into how we can help women work with their physiology. Key points I've taken away today are that we can use the menstrual cycle as an ergonomic aid, really, to improve performance. Great tips on creatine, 3 to 5 grams, is that right?

Stacy: Yep.

Lisa: Yep. Fantastic. I can't wait to try that one. And I guess just working with our cycle and understanding that we perform differently perhaps at different cycles and we can adapt depending on our own personal style.

Stacy: Yes. Perfect. So you have to report back on all of the things and let me know how it goes.

Lisa: I will. Thank you. It's been fantastic.

Stacy: Awesome. Thanks so much.

Lisa: Thank you, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the fx Medicine website. I'm Lisa Costa-Bir, and thanks for joining us. We'll see you next time.


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