Longevity Debate: The Truth About Weight Loss, Muscle, and Creatine!  ## Metadata - Author: [[The Diary Of A CEO with Steven Bartlett]] - Full Title: Longevity Debate: The Truth About Weight Loss, Muscle, and Creatine! - Category: #podcasts - URL: https://share.snipd.com/episode/ba3dfe91-1007-4467-af31-a3b4c79711ca ## Document Notes ## Highlights - **Strength Trumps Skinny For Longevity** - Women were taught to prioritise thinness over strength, producing an epidemic of osteoporosis and frailty. - Building muscle is a foundational health strategy for women's long-term brain and metabolic health. Transcript: Vonda Wright Muscle matters because it helps your brain produce more neurons. And that's super important for brain health. As far as protection as we age, it's directly correlative to the amount of muscle that we have. Natalie Crawford And if you have something like PCOS or endometriosis, it's even more important for you because building muscle is going to fight insulin resistance and inflammation. Steven Bartlett I've got two questions to add. Should women exercise differently across the menstrual cycle? And what is the reason why women hear what you guys say and they don't do it? Mary Claire Haver I'm so glad we're having this conversation. Natalie Crawford We're back with the leading voices in women's health to unlock the specific insights, data, and tools needed to combat the growing challenges women face throughout their lives. Stacy Sims For women, forever it was all about aesthetics. I'm healthy, I'm thin. Because they are under the assumption through sociocultural ideas that a woman is coming to the gym to lose weight, not to get strong, not to gain muscle. Mary Claire Haver But what we've ended up with is an epidemic of osteoporosis and frailty and really dementia. Vonda Wright Where 40 to 50% of women will have low bone density, 70% of all hip fractures happen in women. And when you have that, 30% of the time, you have a chance of dying in one year. ([Time 0:00:09](https://share.snipd.com/snip/4fa88adf-c079-4dce-8f30-65348c797b14)) - **Make Strength Training Nonnegotiable** - Make strength and resistance training your core habit regardless of cycle phase or pregnancy status. - Use how you feel day-to-day to schedule higher intensity sessions when energy peaks. Transcript: Stacy Sims This is the nuance. And this is something if you'd asked me maybe five years ago, I would have said, sure, from a molecular level, we see that there are certain things that happen with estrogen being in isolation For the most part. And then when you have estrogen progesterone, we see their metabolic shifts, we see their temperature shifts. But the caveat is, we don't know if a woman ovulates or not. And I'm sure that Natalie can, you some stats about the anovulatory incidences in most women. If we were to understand and know when a woman ovulates, in addition to how she feels across her cycle, then she can individually tailor her menstrual cycle to her training. But for general plan, we can't do that. Natalie Crawford I think it's important that, you know, building muscle, using muscle, consistency is a huge part of effectiveness when it comes to exercise or to building strength. And so one fear we have when we say, do this in one phase of your cycle and do that in another phase, is that if, you know, 15% of patients are not ovulating, or they have no idea when their Follicular and luteal phases are, are they then doing overall less because they're waiting on this directive to tell them what? What is not untrue, though, and how I frame this to patients is that strength and resistance training should be the core of what you're doing regardless of the phase of the cycle you're In, regardless if you're pregnant, regardless if we're doing fertility treatments, building muscle, using your muscle. Now, what you do on other days is where you should allow yourself to say, how do I feel this day? What do I need this day? And be okay with giving yourself the grace that that may look different on your period, in your follicular phase, in your luteal phase, and saying doing something and moving your body Is still ultimately, we're all going to agree, better than sitting on the couch. Exactly. Many women will say they have more energy in that late follicular phase. And so if you are looking at your workout structure, this is a day I want to try heavier weights or more reps. It can be smart to put that in a time where you have a higher chance of being successful. That's how I explain it. Stacy Sims I'm like, if you have your own data and you know which days you feel really fantastic, that's where you want to put your higher intensity, your heavier lifting, because you know that You're going to hit those training metrics. ([Time 0:05:11](https://share.snipd.com/snip/3b468ec1-7b4a-46b4-bb6d-c3e92a461dfe)) - **Energy Peaks Before Ovulation** - Many women feel strongest about 6–14 days into their cycle when estrogen rises and carbohydrate access improves. - Ovulation responses vary: some feel great, others experience pain or transient low mood, so individualise training. Transcript: Stacy Sims Right here five to seven days before ovulation some women feel really great around ovulation some have a transient where they'll feel really awful on and around ovulation. And maybe 24 hours later, they feel really fantastic. Most women are variable through the early luteal phase. So if we think about day 6 to 14, that's when we see women feel really robust and strong and feel like they can take on the world. Vonda Wright Because estrogen is rising. Stacy Sims Yeah, exactly. And you see the physiologic changes, heart rate variability, resting heart rate. Your immune system is more prone to taking on virus and bacteria. It's not pro-inflammatory, so you have that working for you. Your core temperature is lower. You can access carbohydrate a lot easier, so you have more availability for fueling to hit high intensities. Then when we see with ovulation, like I said, some women feel really fantastic right around the time of ovulation because of the estrogen surge. Natalie Crawford Some have transient where they don't feel so great. When that follicle ruptures and the egg is released, the granulosa cells that are surrounding it, which is what actually makes estrogen, get disrupted. And so some women feel that transient breakage and their estrogens dropping before it reforms to become the corpus luteum and make again. So you have this high peak estrogen. And then some women are really sensitive to these hormonal changes and they feel that drop. So that ovulation day may not always be your very best feeling day which makes women feel like it should be and like something's wrong with them on a side note we did um survey on women experiencing Stacy Sims Pain on ovulation because it's something was never talked about middle schmurts yes exactly middle schmurts middle schmurts we had so you can feel the follicle rupturing and that's Natalie Crawford Called middle schmurts so it's German for in the middle because it tends to happen in the middle of your cycle when you ovulate. Steven Bartlett And it's painful. It's a pain. Stacy Sims It can be. It's just a pain. It's like a cyst bursting inside your body. And then some women are down for the count because of it. So they don't plan any physical activity around that because they just can't, from a physical and mental standpoint, put themselves through anything. So that's why I'm saying like ovulation, some women feel bulletproof. Other women who have this transient feeling of really flatness and pain. And then afterwards in these early luteal phase, so day 16 to about day 22 is variable. Well, some women will feel like on top of the world still. Other women will feel, I can't quite hit eye intensities. And then in general, these few days, about day 24 to 27, before those hormones actually drop, this is where you have your PMS, your premenstrual syndrome and cramping and fatigue. ([Time 0:07:47](https://share.snipd.com/snip/eb93071f-19b7-4ea9-9cba-7454ed2a6f20)) - **Polarise Training For Real Adaptation** - Periodise training: mix low-intensity recovery days with short, maximal intensity sessions to create real adaptation. - Avoid daily moderate-intensity workouts that neither allow recovery nor provoke strong adaptive responses. Transcript: Stacy Sims This is where we have to think about periodization, first lifestyle, but also how a woman is feeling. We don't want people to do high intensity interval training every day because that's just not going to create an adaptive response. We have to think about the reason why we're exercising is to create a stress that the body's going to respond to. We don't get fitter during exercise. We get fitter from the stimulus of exercise and the recovery from it. So if someone's doing high-intensity interval training every day or five days a week, they're not ever going to get that subsequent recovery to be able to hit those high intensities And that stress that we want. We talk about intensity during our reproductive years. You can pretty much get away with whatever you want to do during your reproductive years because you have the benefit of our hormones working for us. We start getting into perimenopause and we start getting into menopause. This is where we have to really carefully look at volume versus intensity. So that means if we're doing lots of stuff, are we doing really purposeful high intensity versus low intensity because we're trying to create what we call a polarization of the training So that when we hit high intensities we're actually hitting the intensities we need to create change but on the other side of it we want to hit really low intensity so that we can have recovery. It gets harder to recover as we get older, regardless if you're male or female. But in perimenopause, we don't have the benefit of estrogen-supporting anti-inflammatory responses. ([Time 0:12:00](https://share.snipd.com/snip/0e45acfa-6793-437e-9d74-0abf61d17dab)) - **Mobilise Before You Load** - Always start sessions with 8–12 minutes of mobility work to open joint capsules before loading. - Use banded joint distraction and dynamic mobilisations to prevent microtears and reduce injury risk. Transcript: Stacy Sims So if she has three days that she can go to the gym and has, well, I should say three one-hour sessions that she could have at the gym in a week over seven days, each one would start with mobilization. So using resistance bands, or maybe you're doing a Pilates reform or warmup. So you're getting through the range of motion. Steven Bartlett Why? Stacy Sims Just to open up the joint capsules, make sure you don't have any restrictions so that you can get really good range of motion for the movements you're going to do next. The next movements would be... Steven Bartlett Does that stuff actually work? I do wonder this. So many of my friends are getting injured at this age because they're my age and a bit older because they walk into the gym and they start picking weights up. Stacy Sims Oh yeah. No, I spend more time mobilizing, I think, than I do actually training now, just to keep range of motion going and keep the joint capsules open. And so that's using the heavy resistance bands to distend and distract all the joint capsules to increase range of motion. Stretching doesn't do that. Stretching will get to an end point of the muscle to allow you to have more flex in the muscle but it's not actually stretching in the joint capsule to give you range of motion so when we Talk about mobility work we want to get into that full range of motion so if you have a stiffening so as i was saying earlier about the guy in my voodoo flossing or voodoo floss is a way where You're creating some blood flow restriction then you go in a range of motion in that blood flow restriction you take the voodoo band off and the blood flow comes back and you go in the range Of motion, get deeper in that range of motion. So it's all about accessing the tissues and making the tissues more viable for increased range of motion so that when you go do the lifting, when you go put on a heavier load, you have better Control, better range of motion and avoid the small little sticky points that cause injuries micro tears yeah yeah uh so it's the micro tears that are going to lead to injury and the micro Tears come when i haven't warmed up properly yeah so here's why it's what would that look like for your shoulder uh i wish i had a rig so you could take one of those thick um big and wrap it Around a rig or or something and you can pull and distend so you're actually pulling the shoulder out okay in different ranges so you can rotate roll pull extend pull what about this so This is more trying to work the muscle okay And you have paleo press as well where you're working rotation, but that's not getting into the joint. So you want to be. So if you're distending, you're pulling back. You're not bending your elbow. You're actually pulling through the shoulder and distracting. And then the band is going to pull you forward to give you resistance to pull your shoulder joint out. And it's not a painful, but you're just really getting into that full joint capsule. You can do that with the hips. ([Time 0:20:16](https://share.snipd.com/snip/5c96b034-ab03-4a11-8069-6e49054b5600)) - **Perimenopause Rapidly Accelerates Bone Loss** - Women lose bone faster during perimenopause because estrogen decline increases osteoclast activity and inflammation. - The perimenopausal decade causes up to 15–20% bone density loss if unaddressed. Transcript: Vonda Wright So this is how it works. So both men and women build bone and peak about up to 25, sometimes 30. And then bone loss plateaus for a little while. Men continue to lose about 1% a year. So men do not arrive with hip fractures or devastating fractures until their 70s or 80s or older. Women also decline slowly until we lose our estrogen. And then the rate of decline, and I'll tell you why it happens for bone, doubles or triples such that you will lose 15 to 20% of your bone density during your perimenopausal period just From loss of estrogen alone because estrogen plays many roles. I've already talked about estrogen being a huge anti-inflammatory. Bones are very sensitive to inflammatory chemicals in your body. Estrogen also directly affects the balance of the two main cells that subtract minerals from bone, the osteoclast, and the cell that builds the bone, the osteoblast. And in well-hormoned times, there is a balance. The body loves balance. We take what we need, we build it back. But because estrogen has such a profound effect on the osteoclast, the Pac-Man bone-eating cell, there's an unbalance and we take more bone than we're capable of building. We're still building bone, but the rate cannot keep up with this. So, with the inflammation, with the direct effects on the osteoclast, women will lose bone density if they do nothing. Well, number one, they're going to lose bone density, but they must do something about it. The reason it's so critical for a 33-year is because you still have your estrogen. So let's learn how to lift heavy. Let's take advantage of the estrogen circulating. Let's learn to have a jumping practice and impact our bones, right? So the way our body tells our bones to build more is there's another little cell called the osteocyte. It sits encased in bone, but it's connected to these other cells by little tunnels that contain fluid. When you jump, the biomechanical impulse of that fluid shifting in the little tunnels is translated into a biochemical stimulation that tells the bone, oh my God, she's jumping around. I need to build more bone. So we need that impact to stimulate the laying down of more bone. ([Time 0:38:02](https://share.snipd.com/snip/735fb9f4-421b-4516-bb6e-c88595f6c78c)) - **One-Hour Workout Template** - Structure a one-hour gym session: mobility warm-up, one heavy compound lift, then plyometrics or sprint work. - Finish with impact/jump training to stimulate bone via ground reaction forces. Transcript: Stacy Sims And then we finish it with some jump training. Jump training. Steven Bartlett Yep. Stacy Sims So plyometric type work, or if we're looking at not having the robustness of doing straight plyos, then you can do band-assisted pogos. You can do low depth jumps. You're getting some impact. The bone, because as Dr. Roy was talking about, it's a multidirectional stress. People think, oh, I run. I'm going to have strong bones. But running doesn't do it. You need multidirectional stress. So if you think about it, when you land, your body has to move. The ground doesn't. So it's called the ground reaction force that comes up through the bone to create that strength. So that ideal situation in a workout for her would be some mobility, some heavy lifting. If we're doing plyo, that's also a sprint-type training, so you're getting a metabolic stress. ([Time 0:44:28](https://share.snipd.com/snip/48ca3f8a-17fc-41dd-80f5-bbf33cc77adf)) - **Supervised Heavy Lifting Builds Bone** - Osteoporotic patients can lift heavy safely under supervision; progressive heavy resistance builds bone. - Protocols like 5 reps x 5 sets near failure produced bone gains without fractures in older women. Transcript: Vonda Wright Lifting and bone growth yes yeah lift more lift more study by dr beck yes she was trying to dispel the myth which i hear every day that you've got osteoporosis, you can't lift weights. And so her study, because we're big proponents of teaching people to progressively lift heavier and heavier, and that scares people, but especially if you think you're going to break. So she did a study where the load was five reps, five sets under a supervised situation. So five reps means that it was heavy enough that at five reps, they were near failure. Right? So these women, all osteoporotic, not only were capable of lifting heavy under supervision, none of them broke, and they built bone. ([Time 0:45:28](https://share.snipd.com/snip/1a863330-b099-4b28-98d1-16e8ac02d89b)) - **Estrogen Affects Muscle Power Directly** - Estrogen supports myosin function; its decline causes early loss of power before visible muscle loss. - Heavy lifting stimulates neuromuscular adaptations that compensate for myosin dysfunction in perimenopause. Transcript: Stacy Sims Guess, influence on myosin. So myosin and actin are our two contractile proteins. So if you think about a sliding filament or coming together, you have myosin and actin that bond together to then pull and move and pull and move. That's how you have a muscle contraction. Estrogen is responsible for how tightly myosin bonds to act in. When we start to lose estrogen or we start to have variability in our estrogen, we get myosin dysfunction. So that means we're not going to get a very strong contraction. Steven Bartlett So we get weaker. Stacy Sims We get weaker. And this is one of the very first things that people complain about to me. I don't have power. I don't have strength. I can't, my grip strength's gone. I don't know, but their body composition hasn't changed yet. So if we think about lifting heavier loads, it's a neuromuscular response. And that direct stimulus creates the adaptive change in myosin that now estrogen isn't responsible for. It's a different external stress that creates that change in myosin to go, yep, I have to grab onto actin and have a very strong contraction. So we see that this dysfunction happens first before we start seeing a change in our lean mass development. So if we are already in the habit of lifting heavier loads, then we can offshoot some of that myosin dysfunction that occurs with the estrogen change. ([Time 0:46:38](https://share.snipd.com/snip/98dceabc-5cf7-4669-b56e-2491954ef4e8)) - **Lactate Production May Protect The Brain** - High-intensity work produces lactate that the heart and brain use as fuel, potentially protecting against Alzheimer's. - Women lose glycolytic fibers with age so producing lactate via intense work supports brain metabolism in midlife. Transcript: Stacy Sims We talk about Alzheimer's and dementia. And one of the reasons I really preface doing high-intensity work is the lactate production, because we're finding more and more research coming out showing that part of the development Of dementia and Alzheimer's in the plaque is a misstep in brain metabolism. So when we're looking at brain metabolism, and the brain uses a lot of glucose, it also uses lactate. Now for women, we have less of the glycolytic or lactate producing fibers, and we tend to lose those with age. Men are born with more, tend to hold on to them more, so it's not necessarily as big an issue for lactate production. Men need to spend more time in the low intensity being able to produce more of our fat burning capacity. But for women doing that high intensity work and being able to produce lactate to then allow the heart and the brain to use that preferential fuel feeds forward to reducing the misstep In this brain metabolism component that occurs. And it's such a sex difference. We're seeing a change in glucose metabolism in and around perimenopause into menopause. So it's a lactate production that is kind of the offshoot of the high intensity work that's super important for brain health as well as... ([Time 1:18:47](https://share.snipd.com/snip/617b8ef3-a233-45a0-b551-7da25ee6bbb6)) - **Lose Fat By Lifting And Protein** - To lose weight healthily, prioritise resistance training and adequate protein rather than endless cardio. - Use a slight calorie deficit plus lifting to recomposition body composition, not just reduce scale weight. Transcript: Stacy Sims Weights lift weight and eat and eat yes absolutely and you could have a very slight calorie deficit towards the end of the evening. Steven Bartlett Running? Stacy Sims As a way of burning calories. The problem is people think that they can out-exercise a bad diet, and you can't. Natalie Crawford Composition of your diet matters immensely. Mary Claire Haver And I hate calling it lose weight. I now call it recomposition. Vonda Wright But let me put it in context. Yeah, go run. You're going to burn 100 calories a mile. Three Girl Scout cookies, three thin mints, U.S. Favorites, is 180 calories. That's my favorite. So you have to run two miles to eat three cookies. Most of us, if you're going to eat cookies, don't eat three-threaded mints. You eat the whole sleeve, right? To your point, it is impossible to out-exercise food unless you're a high-level athlete who's burning 1,000 calories. Even then, no, because we look at diet composition, and ([Time 1:25:10](https://share.snipd.com/snip/fed65bcc-c494-4b5e-8c5d-36915a2a8bbc)) - **Use GLP-1s With Supervision And Strength Plan** - Treat GLP-1s as a tool, not a standalone fix: mandate resistance training and adequate protein while prescribing. - Monitor muscle and bone via body composition and stop or adjust medication if unacceptable muscle loss occurs. Transcript: Steven Bartlett Isn't the typical story of people that start a Zenpeg, though they see it on Instagram. And then a week after, I'll be at their house and they'll tell me, I'm on a Zenpeg. And it's usually just someone sees it online, they hear it on a podcast, and they're on it within a couple of days. Mary Claire Haver The access is getting easier. The price is coming down. And there is, for any medication, there are risks, there are benefits. And there's ways that will promote health. Natalie Crawford And with any medication, you can not promote health if you give. I mean, GLP-1s can be revolutionary for certain people. A lot of people are not training for a 5K, let alone anything else. And we know if we go very simply, fat cells, right, they make a different type of estrogen. They're inflammatory. You have insulin resistance. And all of this sets you up at a deficit to say, I want to get healthier. For women, we'll say you have PCOS, who already have a predisposition for insulin resistance. They have a harder time losing weight because now they're also storing visceral fat. We know they get on this cycle with hormonal change. You know, being on Ozimbic allows them to lose weight and combat insulin resistance in a faster way than they've ever been able to do before. And especially when it comes to fertility and you're on a timeline, that can be really revolutionary. When you lose weight because that estrone decreases, many women with PCOS, if they were overweight, will start ovulating again because that suppression from the additional estrogen Is gone and their inflammation markers go down, their insulin resistance decreases. So there's a subset of people who have found their life changed by them. And we never want to discredit that. Many people have had difficulty losing weight, chronic medical conditions have been able to reverse them. And this has been a tool in the toolbox. Steven Bartlett Because about 70% of Americans would fit in that category of chronic health conditions, difficulty losing weight. Mary Claire Haver 73% right now are overweight or obese. Steven Bartlett So should 73% of Americans be on GLP once? Natalie Crawford And it's higher in women. Well, we always, one common thing is having tools in the toolbox and being able to know when to use them, when to offer them. Just like when we have the HRT discussion, we don't want to see people, we'll say women for this discussion, being offered a therapeutic option because or not choosing it out of fear Steven Bartlett Well when i hear that it's gonna help me lose weight and i've got two options i can go out and lift all these weights stacy and i can which you know one day i don't yeah it's hard isn't it go To the gym i have to put my shoes on all these all these things or i can take this injection and lose all your muscle and lose your bone and end up like the little floating figure in Wally movie Stacy Sims That I've talked about before, right? And that's my fear of just blanket people use. Natalie Crawford But you're also, whether you mean to or not, giving the illusion that, you know, willpower is all you need to lose weight, right, by what you said, right, I can either do these hard things, Or I can choose this medication, which appears to be the easier way out. And two things can be true at once, people can work extremely hard, maybe they don't understand exactly what they should be doing. And that's part of what we're trying to change the discussion on. But reversing some metabolic change, even initially, can make a big difference in their game plan. But you will lose body weight on these medications. And so you have to have somebody, you know, guiding the ship. I think what we all don't love is the access without oversight, meaning nobody's helping you say, how are you not losing muscle? How are you doing this in a safe fashion? You can just text somebody on an app and suddenly get medication, have the medication shipped to your house. Mary Claire Haver You know, in our clinic, it is an hour long. Now they're coming in to discuss the GLP-1 option. It is an hour long visit of risks, benefits, side effects, protein intake, resistance training, mandatory. We will follow your bone density. We will follow your bone mass. I mean, your muscle mass. You know, we have these scanners. These are great. Available. And we're not going to get to a number on the scale and sacrifice your long-term health. And my patients are drinking the Kool-Aid. They're coming in. They've found, you know, they're coming to you for a reason. Yeah. And so I'm a little bit unique in my clinic in that I have a social media following and people kind of watch a few things before they come see me. So they know my, they're not shocked by me giving this advice because I give it all day on social media. Steven Bartlett So if you give them the Zempec, but they still don't go to the gym, they still don't do anything else. Mary Claire Haver Then we'll stop giving it to you. They won't be healthy. And they know that. We've talked to them about that. We've explained it on the front end. That there's a tool in your toolkit because we can see their muscle mass. We won't renew the prescription if they've lost the muscle mass. Vonda Wright So if you are losing weight and not lifting and eating enough protein on Ozempic or any way else, and you do a body composition, you may see total weight lost. ([Time 1:27:45](https://share.snipd.com/snip/00bf8c63-9083-41d4-a7d9-b7fcd8e57d29)) - **Eat Protein To Preserve And Build Muscle** - Increase protein well above the RDA when training: aim ~1.0 g per ideal pound (≈1.6 g/kg). - Prioritise protein at each meal to preserve and build muscle and reduce frailty risk. Transcript: Vonda Wright Like to approach nutrition for people is first having people notice what they're eating. And then from that, break it down into, well, how much of it is protein? How much it is fat? How much is carbs? Without that kind of education, it's almost meaningless. So when we've done that, and I'm making recommendations for protein, we will not build the muscle we need to build. We will not get stronger the way we're capable of getting stronger, A, if we're not eating enough, and B, if we're not taking enough protein. So the RDA recommendations of 0.8 grams per kilogram is survival doses of protein, like sitting on a chair like a mushroom. Preventing malnutrition is the goal of it. It is not for active people. It is not for living your best life, people. 0.8. The recommended daily intake. Is 0.8 grams per kilogram of lean body mass. So it's low. It's very low. Supports, easily supports, let's use pounds, 0.86 grams per pound for lifting people. I recommend over a gram, a gram for ideal pound, because I'm presuming that the people I'm taking care of are going to start being active, that we're trying to build muscle, that we're Not in starvation mode. ([Time 1:41:10](https://share.snipd.com/snip/15921d4d-1662-479c-966b-ee5223758c8a)) - **Exercise Often Matches Fasting Benefits For Women** - Many benefits attributed to fasting (autophagy, telomere effects) are also achieved via exercise and quality sleep. - For women, long fasts risk hypothalamic dysfunction, visceral fat gain, and reproductive disruption. Transcript: Stacy Sims Of all, you know, but the basic idea of fasting, if we want to use the term fasting, we have to look at it as, are we talking about intermittent fasting or time restricted eating? So intermittent fasting is kind of like, you know, your water fast, your five day, two day, all that kind of crazy stuff, which for the most part, men can get away with and have a positive Impact on body composition, but women can't. If we want to talk about time restricted eating and working with our circadian rhythm, which is optimal, then you have breakfast within or food within a half an hour of waking up that Helps dampen that ghrelin and cortisol response I talked about before so that everything's coming down, your hormones are starting to work properly, and your body's like, great, I'm ready to go. I can handle this. And then you're eating at regular intervals, and I try to have people have protein and fiber at every eating interval so that they are maximizing protein and fiber intake. Then you have dinner, and then you don't eat after dinner. What do you mean by every eating interval? So breakfast, maybe you have a snack. If we're looking at training or exercise, if you're splitting your breakfast, then you're having some protein and carb before, you're having the rest of your protein or more protein Afterwards, and then you're having some protein and some fiber at lunch. So you're having maybe tempeh or tofu or salmon with salad or fruit and veg. So every time you're eating, you have a protein and fiber focus. Steven Bartlett So time-restricted eating is within a 24-hour period? Stacy Sims So you're looking at, I'm going to eat during the day when my body needs it, and I'm going to stop eating when I finish dinner. So I have about a two three hour break before i go to bed so that when i go to bed i'm not trying to digest food my body can get into the parasympathetic responses it needs to to sleep well for Natalie Crawford Reparation and then i eat again at what time when you wake up in the morning it's typically about 12 hours of eating and 12 hours of not so you're trying to follow that circadian rhythm And work with your hormones it can also when we do have that period of time, which maybe that sounds very intuitive, but a lot of people are eating at 10 p.m. They're snacking on food, then they're trying to go to bed, and then they're getting up. When you give your body a little bit longer, so at 12 hours time, is when your body will really efficiently be using up all your glucose, really dropping some of those insulin levels. But it's not so much that it's stressful. And we're using stress very generically here. But on a cellular level, long periods of fasting for women specifically can be very stressful to the body. And that's why if you think about Stacey's example of what happened in two fasting periods to a man and a woman, things are going to happen to your body if it thinks it's being in starvation. So we don't want to put your body in a starve state. We're just trying to give it a time period without food so that it can start to process the energy that's available differently. Steven Bartlett Why not though? What's going to happen? I understand from what we talked about earlier that my fertility, my cycle is going to change. But is that it well there's there's adaptive stress and then there's stress to the point of your you're hurting yourself men can you said that men can do longer fast they can do longer Natalie Crawford Fast and it can show to actually you know be something that might be advantageous for them for how their body is made might increase their focus and some other metrics. But for women, these longer periods are actually going to promote more visceral fat storage and become pro-inflammatory. And you said it a little casually, but disrupting your hypothalamus and shutting off your hormone system will cause a low estrogen state. And that's very problematic, as we've talked about. So thinking about your body should not be in a starved state. So utilizing time-restricted eating, meaning I'm going to eat within my circadian rhythm, the hours that there is sun outside, how your body is made to function, is working with your Biology. If you're saying I'm going to not eat for three days because I'm doing this fasting period, for women, that's going to induce a stressful state where you're going to start to store more Stacy Sims As visceral fat and cause more inflammation. And if we bring it into the, you know, people holding a fast till noon or after, you're phase shifting. So it's like you're having social jet lag, where if you're phase shifting, your hormone responses, your appetite hormones, then you're not going to get into a good sleep because your Body's like, it's not time to go to sleep. Your melatonin peak in women usually peaks around nine o'clock. So you start to get sleepy. That gets shifted to 11, 12. So you're not actually going to get good sleep because you now have reset your melatonin responses. So we want women to understand that time restricted eating when you're not eating when in the dark is really beneficial, right? Natalie Crawford Easiest way to say it. Stacy Sims Easiest way to say it. Yeah. You're fueling for your body during the day because that's when it needs the fuel. That's when we want to be able to create an environment that's supportive to hormone health, supportive to muscle growth, to brain health, to all the things, and reducing stress when We can control that stress. So when you start phase shifting and holding fast and creating this stress on a circadian level, knowing that there's a circadian response on every cell as well as a total body circadian Rhythm, that if you shift that, then we start seeing a lot of metabolic dysfunction, poor sleep. And unfortunately, we see this in shift workers because that's what's happening. They're having circadian shift. Steven Bartlett And they have significantly lower longevity. They live, what, I think I had 14 years less if you're working night shifts. Natalie Crawford I don't know. You have higher rates of infertility, higher rates of pregnancy loss. You're more metabolically unhealthy. Of course, we're generalizing a group of people. And I think we've all had moments of life where shift work was part of what we had to do. But night shift work, most people are not getting enough sleep during the day. And they're what we call flipping back and forth, right? Because you want to be on a daytime schedule on your off days and live your life. That you're constantly sacrificing what your body needs. And what I tell people is you may, if you can get off of that, it will be a healthier life pattern. Really prioritize trying to get enough sleep, making sure that you're taking care of yourself in the other time periods because you're set up for a place that is going to cause hormone Dysfunction and impact your metabolic health. Steven Bartlett You believe the same I believe. Vonda Wright I advocate feeding ourselves for optimum health. To be any kind of active you must feed yourself and um stop eating three time three hours before bed so what do you think of people that do these longer fasts do you think that they've just Steven Bartlett Been given poor advice because i know i was talking about mel earlier and i know she does frequently does three-day fasts because i think people think they've heard this term autophagy Stacy Sims Autophagy is the term take it stacy so this is the thing ([Time 1:45:40](https://share.snipd.com/snip/53fabb0d-71b2-4663-a8a5-c66f4699171e)) - **Don't Train Hard On An Empty Stomach** - Avoid fasted training if you want to preserve muscle; eat before exercise to protect amino acids from being used as fuel. - Women break down more amino acids in fasted exercise, risking muscle loss and hormonal disruption. Transcript: Stacy Sims For women, no. That's what you taught me. For men, I'm going to say no as well, because when we're looking at the fueling mechanics of exercise, muscle is a very metabolically active tissue. If your body is trying to fuel itself, it's going to break down the very first thing that's creating an energetic need, which is muscle. We see in women, women, lose muscle. You're going to break it down and use the amino acids as fuel. You can tap into blood glucose and some fat, but when you aren't bringing blood glucose up through eating first, it's really hard for your body to understand that this is what you want It to do. So it's like, okay, I need to conserve fat. I don't want to go through all the glucose that I have because I need it for brain health. So I'm going to start feeding more amino acids and to fuel what I'm doing. For women, we already use more amino acid than men. So if we're looking at fasted training, then we're already increasing the amount of lean mass that our body's going to break down to use as fuel. ([Time 1:53:38](https://share.snipd.com/snip/58ca721d-5aa2-40ce-b38b-b56b82d95706)) - **Daily Creatine Benefits Brain And Muscle** - Take creatine (3–5 g/day) as a simple, evidence-backed supplement for muscle, brain and fatigue support. - Women often have lower creatine stores and benefit from modest daily supplementation for cognition and recovery. Transcript: Stacy Sims That's the old school thought when we're thinking about creatine and how it got its chops in the supplement world we're looking at muscle performance and taking five grams four times A day with some carbohydrate to enhance muscle performance is how it started but when you start really disseminating down into the health aspects of creatine creatine is used in every Fast energetic of the body so So that means your brain, your heart, your gut, muscle, everything that requires energy from zero to 30 seconds, creatine is involved. Women have about 70-80 % of the stores of men. And when we start looking at all the different types of diets that are out there, lots of exclusionary food diets, then the intake of creatine is lower. What we're finding in the research from health perspective is that it does so many positive things when you're able to saturate the tissues to bring it up with even a small dose of three To five grams a day. Our liver makes about three, but we don't necessarily eat enough to help supplement all of the tissue. How much would it take like 12 chicken breasts or something? 22. Okay. 22 chicken breasts. A lot. So when we look at the supplementation and being able to saturate all of our tissues thoroughly to support those fast energetics, we see things like better cognition, focus, we see A faster recovery from small traumatic, like a friend's daughter hit her head on the laundry door of the dryer and got a TBI or a small concussion from that, started using creatine, came Out of it a lot faster. I mean, there are things that help with brain matasm. We see women who have incidences with IBS or gut issues, and they're using creatine, it helps decrease the symptomology. We're seeing now studies coming out about fatigue. And this is where the 0.38 grams per kilogram of body weight or the equivalent of 20 grams if you're 60 kilos helps with fatigue and focus, especially if you're under a lot of high stress. Because if you're under a lot of high stress, your body's going through a lot of blood glucose trying to keep up with that stress. So creatine isn't just the bodybuilding set. There's so many different health benefits and it keeps coming out with more and more research to show how beneficial creatine is. ([Time 2:01:56](https://share.snipd.com/snip/f27d28fb-235c-4d0a-b6b4-a226d7d79483)) - **Prioritise Vitamin D And Fiber** - Supplement vitamin D and ensure adequate fiber intake as baseline measures for midlife women. - Check levels and supplement vitamin D up to ~4,000 IU/day if deficient under medical guidance. Transcript: Mary Claire Haver A... Okay. So in general, we're not going to cure menopause with supplements. Let me just take straight up. Okay. Most women are going to be deficient in fiber and most women are going to be deficient in vitamin D. And vitamin D is hugely important in multiple enzymatic processes in our body. And it's really hard to get enough through our nutrition, even eating stacks of salmon a day, which is really high in vitamin D. So about 80% of my patients are not only just low in vitamin D, they're deficient. So that is one that we can supplement safely up to about 4,000 IUs, international units, is how vitamin D is measured, a day without worries of becoming toxic or having too much vitamin D, which is possible. And so usually I'm having creatine. Absolutely. It's like a go-to. And we're looking at her nutritional profile. ([Time 2:04:14](https://share.snipd.com/snip/22227fd1-c184-4ef1-b350-90be5575cde8)) - **A Practical Longevity Supplement Stack** - For longevity-focused supplementation, prioritise vitamin D, magnesium, omega-3s, creatine and consider NMN for NAD+ support. - Treat precursors (NMN/NR) rather than IV NAD+, and check intracellular NAD+ if monitoring. Transcript: Vonda Wright Vitamin D. Magnesium is critically important for a variety of metabolic functions. Omega-3 for anti-inflammation. Creatine, I'm a big fan of. If we move looking at senescent cell load and inflammation, we haven't really talked about longevity, but senescent cells are those cells left over from normal function that are so Damaged that they can't flip into programmed cell deaths. So they circulate around and produce noxious chemicals that can lead to a variety of disease. So we want to minimize those. And one way to do it is lifestyle. Another way is to use an herb called fisetan. So I add that on. And then also, I do myself and check levels on my people of intracellular NAD+. NAD is a coenzyme in 300 metabolic reactions. It's an energetic pathway. Now, it's very popular right now. And the critical differentiator for me is that taking whole molecule NAD, such as in IVs, our body needs to make it. So for myself and for my people, I supplement with NMN, which is the immediate precursor of NAD +, so that my body can then turn it into NAD +, and it can work intracellularly. It can also be delivered two reactions out in the form of NR. These are in the B vitamin categories. So that in two reactions, your body makes NAD+. So the data does not show that you can IV NAD plus for efficacy because it works intracellularly. So you supplement its precursor. ([Time 2:07:40](https://share.snipd.com/snip/a699d91c-1cd4-40cd-8d4d-bf679a618bf7)) - **Small Toxin Reductions Add Up** - Environmental toxins include endocrine disruptors, microplastics and behavioural toxins, all adding to inflammatory burden. - Many small exposure reductions (kitchen plastics, receipts, cosmetics) accumulate to meaningful risk reduction. Transcript: Natalie Crawford It's anything in our world that is impacting your body and how it functions. There's a few different types, right? So we have endocrine disrupting chemicals. These are actual toxins in the environment, in cosmetics, our kitchen, our food, that change how our endocrine system works, our hormones. There's also things like microplastics, like you mentioned, which are actually going to deposit in our body and can cause fibrosis even in our ovaries, therefore changing how an organ's Able to respond, even if it is given normal hormone signals. And then I also lump into this category, behavioral toxins, right? Things like alcohol, marijuana, cigarettes, the choices that are toxic in our world as well. So that toxins is kind of a large category. There are some toxins you can control. You can try to filter your water. You can learn what is in your water so that you can say, you know, EWG, this is my zip code. This is what's in my tap water. What type of filter might I need to try to have healthier drinking water in my home? You can change what you're cooking with, not using nonstick cookware or Teflon. You can get rid of plastics and especially what you're putting hot foods and beverages in because the heat is allowing those toxins to leak into those things. And then as Dr. Haver said, our cosmetics, things that you use every single day that you put in and on your body are things that you're having a higher exposure to. And it's really important to decrease those because things like air quality, you might not have as much control over based on where you live. And there's so many toxins in our world in general that it's unrealistic to say, let's avoid all of them. And because of this, we have that same mentality that we see with exercise sometimes. Well, it's just there's too many. I can't avoid them all. So I will ignore this category because it's easier to just do nothing instead of making active decisions to start to live a less toxic life. Steven Bartlett What changes have you made to remove pollutants and environmental toxins from your lives? Because we're in that fertility journey. I remember I came in one day and like all my shampoo and stuff had gone. Natalie Crawford Yeah. So you're starting to look through your products and getting rid of things that have endocrine disruptors in them. You want to look, the kitchen is probably the greatest source of exposure for most people. So there's really no need to have any plastics in your kitchen. So getting rid of them. But many people don't think about when you do have processed foods, the wrapping, the container, anything that's coming packaged likely has toxins in it. When you order DoorDash and it comes and you have it in a container, that's often hot food in a container that is leaching chemicals into it. So a simple thing is take it out of that right away, even if you're not eating it. Put it into something glass or a different type of container. So you can try to minimize that exposure, thinking about hot beverages, things that go in the microwave or the dishwasher, especially, but then other things like thermal receipts. ([Time 2:11:20](https://share.snipd.com/snip/54195118-251d-44a9-9162-500d1d7e560f)) - **Treat Sleep As Nonnegotiable** - Prioritise consistent, high-quality sleep as the foundational pillar for hormonal, metabolic and reproductive health. - Aim for 7–9 hours of actual sleep, fix circadian timing, and avoid medication-dependence for sleep. Transcript: Vonda Wright I say that because we think sleep is just passing out. Like we're not conscious. Well, that may be true from our viewpoint, but it is the most regenerative period in our day. Actually, the brain is processing information, getting rid of toxins. The body is able to settle and, again, get rid of toxins. But many women in midlife have completely disrupted sleep because estrogen is critical. Critical for sleep patterns. Many women wake up at 337 or thereabouts, either with a plummeting blood sugar or that seems to be around the time in the middle of the night that the sleep disruption has. So this broken up sleep, if you don't do it, then all the lifestyle things, Stacey and the rest of us have been talking about, are nearly impossible to do if you're under-recovered. And so I have made, after nearly 11 years of not sleeping because of training and child, a religion almost. Like, I am dedicated to this function. I do not eat three hours before I go to sleep. It's one of the primary reasons that I made the decision to stop drinking alcohol, because that completely disrupted my sleep. And I am more conscious of circadian rhythm than I've ever been in my life, meaning I go to bed when I'm, except probably when I'm traveling, but at the exact same time every night. But more importantly, get up at the exact same time every day to start my circadian day and to start my adenosine usage so that by 930 at night, I'm ready to rest. It's that important. Steven Bartlett A woman's guide to aging with power, unbreakable. Vonda Wright Yes, unbreakable. Steven Bartlett And central to that is circadian rhythms and sleep, right? Vonda Wright Yeah. It is, because the premise of this book is that women are already winning the longevity race, but we suffer longer. And we have this vision of women aging, which is usually a vision of frailty. But through the mindset changes, through the behavior such as sleep and lifting and considering hormones, we can age in a different way. So I'm trying to re-educate the world that a woman's destiny is not frailty. A woman can age powerfully, but not if we sit around and wait for time to make us its victim. We must be proactive. And sleep is one component of that. This should be the very first thing you do. Sleep sets the stage for your entire day. Natalie Crawford It's really that foundation of your health. If you are going to start the day in a sleep deficit, you're starting out stressed, inflamed, insulin resistant, there's going to be no behaviors you can do during the day that are going To overcome the deficit. And we know that women who get less sleep, they take longer to get pregnant, they have higher rates of infertility. We know that men who get less sleep have lower sperm parameters and lower testosterone levels. So if we are saying, you Steven, you know, what's one thing you might be able to do? Well, are you sleeping well? That's one of the first things you can start to do to say, am I getting seven to nine hours of good quality sleep? That's not just time in bed because Mary Claire has her phone on her. That is actual sleeping time. And that makes a huge difference in trying to achieve, you know, a hormonal health, which is really what we're all saying here is how do we get our body in the best, quote unquote, balance That we can, which means working with the different building blocks of our body in the most optimal way for as long as possible to be healthy. Stacy Sims And even if we're not looking from a fertility standpoint, you can't invoke any kind of metabolic or body composition change without adequate sleep. So that's what I mean. ([Time 2:18:40](https://share.snipd.com/snip/81a8b5a9-ae6a-45f6-95e4-0036717feb93)) - **Screen For Sleep Apnea In Disturbed Sleep** - If midlife women wake repeatedly from night sweats or unexplained arousals, screen for sleep apnea rather than assuming normal menopause. - Women present differently and over 50% of female sleep apnea remains undiagnosed, harming long-term brain and cardiovascular health. Transcript: Mary Claire Haver Which I now discuss with my patients, is if women wake up in menopause from hot flashes, from night sweats, and then the relaxation we get from progesterone is gone, so we can add that Back in. So say we've done all the things, we've given her a touch of melatonin, we've put her on hormones, she is still waking up at three in the morning consistently. She deserves a workup for sleep apnea because women disease differently than men. Men with sleep apnea it's a very common presentation of snoring they're waking up the partner you know all these things women are much quieter about it they still have the palate that Falls back and relaxation and that's hormonally driven for a lot of women and so they're becoming hypoxic in the middle of the night from you know that's one of those side effects of having Sleep apnea as you stop breathing and your oxygen levels decline, you become hypoxic. But we are not recognizing it in women. More than 50% of women are going undiagnosed and are living shorter life, having more Alzheimer's because of this. So if I have a patient coming in and we've done everything and she is still consistently getting up, I'm sending her for a sleep apnea evaluation. ([Time 2:27:52](https://share.snipd.com/snip/e0a3a122-435e-4d97-b7a9-1b03526da844)) - **Own Your Midlife Health Journey** - Become the CEO of your own healthcare: ask questions, bring checklists, and seek clinicians who specialise in midlife women's health. - Start preventive testing earlier (bones, hormones) rather than waiting for standard late-age screening thresholds. Transcript: Stacy Sims So it's asking questions. It's sharing information. Most of all, taking up the space because you've earned it. I get so tired of the rhetoric that women should be small and demure and be like a delicate flower and things are happening to them that they can't control. I want the narrative to shift. I want people to say, I own the space, I'm taking up the space. And it's my, I don't like to use the word right, because it invokes a lot of angst. But it is your ability to understand your own body and advocate for yourself that's going to allow you to take up that space and get the answers that you want. I've been advocating for so many women, myself included, and the pushback that you get from the medical society is real. It's not that they necessarily are trying to gaslight you, but it's just a product of the system. So you do have to push those boundaries. You do have to ask those hard questions. ([Time 2:32:33](https://share.snipd.com/snip/6196b8ff-8876-40f5-98f3-9f3057380a26))